This is what I like to call the "snugglee burritto" with a quote of the day: "I don't remember where you are from!"

1st Journal Club

High Altitude: The role of Acetazolamide by Dave and Tim
High Altitude: the role of Viagra by Maggie and Kristina
Current Mgmt of Frost Bite by Zev and Jarrell
Current Mgmt of Drugs with and in Hypothermia by Jake and Ali
Current Mgmt of Drugs with and in Hyperthermia by Connel and Ken
Drowning by Ryan and Sarah

Articles due to Dr Macias by Tues March 4th

Rides to Cabezon

Dave: Connel, Kim and Maggie
Jan: Brain, Jennifer and Kristina
Jake: Zev, Dave and Allen
Darryl: Joe and Ali
Allison: Mary, Whitney and Don
Ryan: Sarah, Tim, Jurrel and Jules

Cabezon Survival Weekend!

Tomorrow am, we meet at the UNM Continuing Ed building Parking Lot bright and early.

Remember - first, this is going to be a lot of fun!

Second - somebody should bring firewood.

Third - we expect some gourmet camp cookery! Hope you chose a good food group.

Remember to bring a small daypack and canteen or camelbak, a flint and steel and compass and signal mirror if you have one (otherwise they will be provided).

Don't forget your sunscreen and sunglasses. Bring raingear and cold weather gear just in case! We have seen first class blizzards out there (probably not this weekend....)

Park in the back of the building (space permitting) Close up map

7:30 am sharp.

Be safe,

Joe Alcock

Best Comment of the Day

Ankle Dislocation Demonstration

This is a video clip of Darryl Macias MD explaining technique to reduce an ankle dislocation for students in the UNM elective.

JA

Tomorrow am: Meet at Sandia Ski Area Lodge at 9:00 am.

Scroll down for Sandia Day lab post for directions and gear list!

I will post a gear list for Cabezon plus directions tomorrow.

JA

Wilderness Medicine Course Lecture

A successful first day of lecture (one of only a handful of classroom days this year) for the Wilderness Medicine Course.

Tomorrow we meet at 8:00 am on the 3rd floor of the Domenici Center for patient transport and improvisation skills sessions.

Wilderness Patient Assessment

This is a preview of tomorrow's UNM Wilderness Medicine lecture: Patient Assessment. We will start by explaining the general approach to wilderness medicine patients: The Scene size-up. The scene size-up has three components: First - Check the scene safety - Is it safe for rescuers to approach and attend to victims. Second - Assess the mechanism of injury - Consider what injury patterns might arise from such a mechanism. Third - Find how many victims are involved - the number of injured persons has large consequences for the rescue effort.

Organize your thoughts (and your report) with the SOAP note setting.

But lets change the SOAP note from its traditional format. Those who are familiar with hospital and clinic use of SOAP notes will understand this acronym as Subjective, Objective, Assessment, and Plan. But who knows what is subjective in the wilderness anyway? I have never liked this, so we are going to change it!

Our new scheme:

"S" stands for Setting, Scene size up and scene Safety.
"O" stands for major Organ system functioning. (ABCDEs)
"A" is the "ample" history and secondary survey.
"P" will remain "plan", but will include plans for contingencies and anticipated problems.

I hope this will be an easier way to understand the Wilderness SOAP note.

We will discuss this in more detail soon!

Joe Alcock MD

Sandia Ski area extravaganza 2/28/08

The Wilderness Medicine Course is visiting the Sandia Ski area, and will meet at the ski lodge at opening time this Thursday. Directions to the Sandia Ski area from Albuquerque are: I40 East to Tijeras. Take route 14 north to Sandia Park. Follow the signs to the Sandia Ski area and park at the lodge for lectures on hypothermia and survival in the snow! We will discuss carpool options tomorrow.

Students who will be joining us should look at this gear list:

Outdoor snow gear - ski wear - sunglasses/screen -swimsuit for some!
Daypack
Ski area: Alpine/Telemark or Snowboards
Backcountry: X-country skis or Snowshoes
Bring or buy lunch/drinks
You may rent cross-country skis/snowshoes at REI - (505) 247-1191
Other gear at Sportz Outdoor (505) 837-9400
Ski Systems (505) 296-9111
UNM outdoor shop 277-8182

JA

Wilderness Medicine Elective

After brief introductions, Jan Gilmore led the UNM Medical School Wilderness Medicine students on a brief hike in the Albuquerque foothills.

Tomorrow students will be presented with Introduction to Wilderness Medicine, Patient Assessment, Leadership, and Gear lectures at room 2112 in the Domenici center. Click on the map for directions.

See you soon!

Greetings from Darryl Macias

Hello from Albuquerque to all taking the March class!
We are excited to have you come out at the end of February. Things are on track for another OUTSTANDING course-so get ready to learn, live, and laugh! Although I am honing my survival skills a bit (practicing with a bow and drill for firestarting), I have been "checking" out the snow for you as well. The backcountry skiing and snowshoeing is really good this year, and the weather is mild after several weeks of pretty cold weather. Dress properly...we are all meeting at the Copper open space for orientation at 1pm on Feb 25. You should have received a map. Registration will be done first (we will also do a little "accounting" work). Then, on a nice hike. Give us a jingle at 505-272-5062, or email me at dmacias@salud.unm.edu for questions. If you have anything that you would like to learn other than what is on the WIIM website, let us know. And tell your friends and family not to get too jealous while you embark on this fun educational event...
Cheers, aloha, namaste, and hasta...Darryl (Dario)

First Day for Wilderness Medicine Course

Welcome to the UNM Wilderness Medicine Course. We will be meeting at the Albuquerque Open Space at the easternmost end of Copper Ave NE at 1:00 pm. Students will meet Karen Lucero, our administrative assistant and will receive syllabi and additional information. Dress warmly, and bring hiking shoes, water and a snack. We will go on a brief excursion after the administrative paperwork is done.

Questions, call Karen Lucero at 272-5062.

Check out this link for videocasts!

Mountain & Marine Medicine Videos!

http://web.mac.com/dmacias5/iWeb/Site/Podcast/Podcast.html

Visit this blog for lecture handouts

This is a handout for a scenario-based lecture during the UNM Wilderness Medicine Course

We will cover bicycling injuries when we go on a mountain biking excursion this month. Cases will be presented involving both road cyclists and mountain bikers.

A brief overview follows.

Injuries come in three categories:

1) Acute trauma

2) Overuse injuries

3) Environmental hazards.

I. Trauma

Mountain biking may have a few subgroups that qualify as extreme sport. As extreme sports become more common, it is important to note that practitioners rarely have medical insurance.

Bicycle Injuries are becoming more common in adults. Safety campaigns are directed mostly at children. In Massachussetts, the incidence of accidents was stable for kids in late 90’s but rose by 30% for adults. 51% were unhelmeted, accounting for 75% of closed head injury. 16% had a positive serum alcohol.

California Cycling Club: Reports a 41% yearly injury rate. Of these, most are minor, 26% required medical care. Only 1% required hospitalization. Extremity injuries accounted for 90% injuries. Head and neck trauma occurred in 12%. Victims were helmeted in 88%. Equipment failure accounted for 7% of injuries.

Downhill mountain bike injuries: common mechanism is going over the handlebars. Among racers, women more at risk than men. Injuries to torso and upper extremities. One report of fatality from diaphragmatic rupture.

Road vs. Mountain bike Injury Pattern.

Mountain bikers have a 40% - 60% decreased incidence of head/face/dental injuries than roadies. Mountain bikers are also less likely to be hospitalized, less likely to have severe injuries. These findings are because of decreased traffic on mountain trails and increased helmet use among mountain bikers.

So it is safer with helmets and safer off road!

A JAMA study showed that helmets provide 4-fold protective effect against head injury. Helmets are 85% effective against head injury and 88% effective against brain injury.

Helmet type does not matter. Hard shell, thin shell (most), and no shell helmets are all equally effective. All must meet ANSI, Snell requirements. Fit is probably the most important consideration when buying a helmet.

Helmets reduce risk of nose and upper face injury by 65%. California helmet legislation has resulted in 18% reduction in head injury for<18 yrs.

II. Overuse injuries.

1. De Quervain’s Disease. Overuse injury of thumb tendon. Repetitive shifting. Pain on inside of wrist and thumb movement.

2. Patellofemoral pain. Overworking the quadriceps. Using too high gears. Hill training.

3. Low Back Pain. Very Common. Fit of bicycle is important.

4. Ulnar tunnel syndrome. Bilateral ulnar distribution numbness. Treat with rest splinting, and NSAIDs.

5. Cyclists palsy. Distal ulnar nerve sensory and motor dysfunction. 92% IN A SERIES OF 25 cyclists completeing 600 km ride. No significant difference on mtn vs road handlebars for motor symptoms, Sensory sx more common in mtn bike group. Gloves, bicycle fit, changing hand positions also important.

6. Scrotal abnormalities. Microlithiasis, Spermatocele. Hydrocele, Scrotoliths, Varicoceles. More common in Biker group.

7. Bilateral Pudendal nerve injury secondary to excessive biking has been reported. ED may develop. However, Bicyclists have no more ED than runners and less ED than the general pop, reflecting healthier subpopulation. Authors recommend comfortable saddles and rear suspension on bikes.

Possible benefit. Mountain bikers have increased bone density and protection from osteoporosis compared to road cyclists.

III. Environmental Injuries

1. Hypothermia. This is rarer than hyperthermia, but can occur with rapidly changing weather conditions.

2. Hyperthermia. A real risk in the desert

3. Hyponatremia. Low serum sodium occurs when salt loss through sweating is accomanied by hypotonic fluid intake - like drinking water without salt-containing foods.

4. Lightning Injury. A real risk in summer afternoons. Lightning is the subject of another lecture.

5. Cactus injury

6. Animal encounters. Bites will be covered separately. Look for upcoming posts!

UNM Wilderness Medicine - Welcome!

Welcome to the UNM Wilderness Medicine Blog! This weblog will be updated daily during the UNM Wilderness Medicine Course. Check for updates, news, directions to events, and other extremely useful information for wilderness medicine course!!!