Patrick Brighton M.D. - Climbers Guide to Treating Medical Emergencies

Copyright 2006 Patrick Brighton

All rights reserved

Printed in the United States of America

Published by Menasha Ridge Press

Distributed by Publishers Group West

First edition, first printing

Library of Congress Cataloging-in-Publication Data

Brighton, Patrick, 1962

Climbers guide for treating medical emergencies / Patrick Brighton.1st ed.

p. cm.

ISBN 978-0-89732-630-8

1. First aid in illness and injury. 2. Medical emergencies. 3. Mountaineering injuries. 4. Sports injuries. I. Title.

RC88.9.M6B75 2005

616.025dc22

2005049624

Illustrations by Tami Knight

Text design by Clare Minges

Cover design by Travis Bryant

Menasha Ridge Press

P.O. Box 43673

Birmingham, AL 35243

www.menasharidge.com

ACKNOWLEDGMENTS

Dont you love it when the Academy Award winners launch into a 30-minute sermon in which they thank everyone from the person who cuts the hair around their poodles butt to Aunt Marthas financial adviser?

There are, however, a number of people who made this work possible, so if you enjoy any portion of it, send your thanks to them. Firstly, Bob Sehlinger at Menasha Ridge Press, who called me out of the blue and said, Why dont you get off your tokhes and do something constructive? Thats paraphrased, by the way. Also, Russell Helms, Molly Merkle, and the rest of the wonderful Menasha Ridge staff. Next, Tami Knight, who has been kind enough to share with us her unsurpassed wit and insight through her illustrations.

Finally, I would like to say thank you to the person who has been my constant companion for the last ten years, and who has truly shown me what it means to be able to enjoy a peaceful, balanced lifemy dear wife, Kimberley.

INTRODUCTION

After a friend encouraged me to write a book regarding medical care for the climbing community I began to wonder what the heck I was getting intoI had never even heard of a medical text for climbers. Shortly thereafter, I asked myself why there werent 8 million such books. Lets see climbers routinely and voluntarily place themselves in situations where the potential for loss of life and limb is almost as great as the chance of Michael Jackson undergoing additional plastic surgery. A treatise concerning medical care for said climbing individuals would seem a natural fit. Anyone reading this text is likely a climber, or at least possesses a passing familiarity with some aspect of climbing. Climbing, as an endeavor, encompasses so many activitiesfrom top-roping inside a climbing gym, to front-pointing frozen waterfalls, to scaling 8,000-meter peaks without supplemental oxygen, as well as many variations. All these different types of climbing activities share common medical threats, and each carries its own set of possible medical misadventures.

Obviously no text (sob! not even this one!) will be able to cover all aspects of all types of climbing emergencies, so my recommendation goes something like this:

Take appropriate, applicable information from this book, fold this in with as much common sense as you can muster, and spread this concoction thickly over the medical crisis situation.

Along those lines, I must now inform you that the information contained herein represents what I anticipate I would do in a given situation and should not be construed as the only, or even definitive, solution to a problem. There, that should keep the lawyers quiet for a while.

As always, prevention remains our staunchest ally in the war against climbing mishaps, so, please, think ahead before you undertake any climbing endeavor, enjoy your particular climbing pursuit with an egoless passion, and remember: gravity never sleeps.

MEDICATIONS

Dispensing

Medicationschemicals synthesized from raw materials ruthlessly extracted from our rapidly vanishing rain forests only to enhance our already pathetically easy existence wait a minute, wrong speech. Anyway, medications really are beneficialeven essential in certain emergency, outdoor settings. Most medications are administered orally ( per os, for you Latin speakers). However, certain medications can be administered only by injection, either into a muscle or vein, and still others are given via inhalation, through patches applied to the skin, or by insertion into the rectum (wait a minute, I dont think I know you that well). Most medicationsibuprofen, Claritin, and so onare given orally and we are all familiar with taking medications this way. In a medical emergency, however, the victim may not be conscious, may have an obstructed airway, or may not be able to otherwise swallow medications. Do not ever attempt to give a victim medications by mouth under these circumstances, or if you have any concern that a pill may end up in his airway instead of his stomach.

ORAL As discussed above, you may give medications to a person who is awake and cooperative and has a clear airway. Remember, medications given by mouth require at least 30 minutes to take effect, so you would probably not give medications this way in a true emergency.

INJECTIONS This is the most expeditious method of delivering immediately available medications but should be performed only by trained personnel. Improperly administering parenteral (injectable) medications can be much more lethal than not giving any medication. There are only a handful of injectable medications that one would potentially use, and these would typically be administered only in dire emergencies by trained rescue personnel.

INHALANTS Medications delivered by this route usually consist of those that a person takes routinely: asthma or allergy meds, for instance. Administering assistance using these medications usually involves helping a person find her steroid asthma inhaler.

PATCHES There is little reason to administer medications by patch in a medical emergency. The medication absorbs slowly and predictably, usually over 6 to 24 hourstoo much time to be of much use in the short term.

SUPPOSITORIES This is actually an excellent way to administer some medications and to break the ice in certain hard-to-start relationships. As weird as it sounds, medications dissolve and are absorbed in the inside lining (mucosa) of the rectum quite efficiently. This is a handy way to get some drugs circulating in victims who are nauseated or are otherwise unable to take medications by mouth. Antinausea medications and Tylenol are the most commonly administered rectal medications. Two salient technique tips apply here: (1) Make sure the medication and the (one hopes) gloved finger that is placing the suppository are well lubricated (with KY jelly, olive oil, water, or such); (2) Make sure that the medication is positioned at least one to two inches inside the rectum. This will ensure that the medicine is within the confines of the rectum, where it can be absorbed.

Precautions

Here comes the cautionary advice. Please, please, please only carry medications that you personally are familiar with administering; you must completely understand the dosage as well as possible side effects and potential interactions with other medications.

Disclaimer

And now for the legal portion of our program: All medicationsthats right all including Tylenol, ibuprofen, and even oxygen, can be lethal if administered inappropriately. The advice in this text represents what I would anticipate doing, having studied medicine and trained and worked in this field for 20-odd years. As with most things in life, there are usually several ways to achieve a positive result in an emergency, so I recommend gathering as much information as you canbeginning with this bookand applying that information in a thoughtful manner compatible with the situation.