Zafren Ken - Medicine for Mountaineering & Other Wilderness Activities

MEDICINE

FOR MOUNTAINEERING

& Other Wilderness Activities

SIXTH EDITION

MEDICINE

FOR MOUNTAINEERING

& Other Wilderness Activities

Edited by James A.Wilkerson, M.D.
Ernest E. Moore, M.D.
Ken Zafren, M.D.

THE MOUNTAINEERS BOOKS is the nonprofit publishing arm of The Mountaineers Club, an organization founded in 1906 and dedicated to the exploration, preservation, and enjoyment of outdoor and wilderness areas.

1001 SW Klickitat Way, Suite 201, Seattle, WA 98134

1967, 1975, 1985, 1992, 2001, 2010 by James A. Wilkerson, M.D.

All rights reserved

First edition 1967. Second edition 1975. Third edition 1985. Fourth edition 1992. Fifth edition 2001. Sixth edition 2010.

No part of this book may be reproduced in any form, or by any electronic, mechanical, or other means, without permission in writing from the publisher.

Distributed in the United Kingdom by Cordee, www.cordee.co.uk

Manufactured in the United States of America

Copy Editor: Heath Lynn Silberfeld / enough said

Cover Design: Peggy Egerdahl

Layout: Marge Mueller, Gray Mouse Graphics

Illustrators: Marjorie Domenowske, Dana Peick, Marge Mueller, Jill Rhead

Front cover photograph: Panoramic view of the Karwendel Range by full moon. Josef Beck/age fotostock

Library of Congress Cataloging-in-Publication Data

Medicine for mountaineering & other wilderness activities / edited by James A. Wilkerson, Ernest E. Moore, Ken Zafren. -- 6th ed.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-59485-076-9 (ppb : alk. paper)

ISBN 978-1-59485-393-7 (e-book)

1. Mountaineering injuries. 2. Outdoor medical emergencies. 3. First aid in illness and injury. I. Wilkerson, James A., 1934-II. Moore, Ernest Eugene. III. Zafren, Ken. IV. Title: Medicine for mountaineering and other wilderness activities.

[DNLM: 1. Mountaineering. 2. Wilderness Medicine. 3. First Aid. 4. Sports Medicine. WB 107 M489 2009]

RC1220.M6M4 2009

617.1027--dc22

2009038107

Printed on recycled paper

C. KIRK AVENT, M.D., Professor of Medicine (retired), Infectious Disease Division, The School of Medicine, The University of Alabama in Birmingham; Birmingham, Alabama

BEN EISEMAN, M.D., Emeritus Professor of Surgery, University of Colorado School of Medicine and Veterans Administration Hospital, Denver, Colorado

BLAIR D. ERB, SR., M.D., Internal Medicine and Cardiology; Past President Wilderness Medical Society, Townsend, Tennessee

BLAIR D. ERB, JR., M.D., FACC, President, Montana Chapter of the American College of Cardiology; Cardiology Consultants of Bozeman, PC, Bozeman, Montana

MICHAEL A. FLIERL, M.D., Orthopedist, Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado Denver School of Medicine, Denver, Colorado

GORDON G. GIESBRECHT, PH.D., Professor of Thermophysiology, University of Manitoba; former board member, Wilderness Medical Society; Winnipeg, MB, Canada

ANDREA R. GRAVATT, M.D., FAAP, FAWM, Pediatric Emergency Physician, Mary Bridge Childrens Hospital, Tacoma, WA; Clinical Assistant Professor, Department of Pediatric Medicine, University of Washington School of Medicine, Seattle, Washington

COLIN K. GRISSOM, M.D., Critical Care Medicine, Intermountain Medical Center, Murray, Utah; Associate Professor, University of Utah Health Sciences Center; President, Wilderness Medical Society; Park City, Utah

PETER H. HACKETT, M.D., Clinical Professor of Emergency Medicine, and Clinical Director, Altitude Research Center, University of Colorado Denver School of Medicine; Director, Institute for Altitude Medicine, Telluride, Colorado

CHRISTOPH E. HEYDE, M.D., Orthopedist, Department of Orthopaedic Surgery, University of Leipzig, Leipzig, Germany

CHARLES S. HOUSTON, M.D., Internist and Cardiologist, Burlington, Vermont; formerly Professor of Medicine, The University of Vermont College of Medicine, Burlington, Vermont

ERIC L. JOHNSON, M.D., Emergency Physician, Director, Emergency Services, Teton Valley Hospital; Associate Clinical Faculty, University of Washington School of Medicine; Past President, Wilderness Medical Society; Driggs, Idaho

ERNEST E. MOORE, M.D., Director, Rocky Mountain Regional Trauma Center, Denver Health Medical Center; Vice Chairman, Department of Surgery, University of Colorado Denver School of Medicine, Denver, Colorado

HUNTER B. MOORE, BA, MS IV, University of Colorado Denver School of Medicine, Denver, Colorado

BRUCE B. PATON, M.D., Emeritus Professor of Clinical Surgery, University of Colorado Health Sciences Center; Past President, Wilderness Medical Society; Denver, Colorado

MARTIN I. RADWIN, M.D., Gastroenterologist; Professional Member, American Avalanche Association; Medical Committee, Mountain Rescue Association; Chief of Gastrointestinal Endoscopy, Pioneer Valley Hospital, Salt Lake City, Utah

LAWRENCE C. SALVESEN, M.D., Psychiatrist; former Staff Psychiatrist, Outpatient Stress Unit, Veterans Administration Hospital, Togus, Maine; Mental Health Member, Southern Maine and Tri-County Stress Debriefing Teams, Pownal, Maine

JOSEPH B. SERRA, M.D., Orthopedist, Assistant Clinical Professor of Orthopedics, University of California Davis School of Medicine, Stockton, California

PHILIP F. STAHEL, M.D., Orthopedist, Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado

GEOFFREY C. TABIN, M.D., Professor of Ophthalmology and Visual Sciences; Director, Division of International Ophthalmology, John A. Moran Eye Center, University of Utah Health Sciences Center; Co-Director Himalayan Cataract Project, Park City, Utah

BUCK TILTON, MS, WEMT; author or coauthor of twenty-six books, more than 1000 magazine articles, and a column for Backpacker; cofounder of the National Outdoor Leadership School (NOLS) Wilderness Medicine Institute, Lander, Wyoming

URS WIGET, M.D., Expedition Physician; Medical Director, Reavita AG; past president, Commission for Mountain Emergency Medicine (ICAR MedCom), Zrich, Switzerland

FORREST C. WILKERSON, Attorney-at-Law; Rock Hill, South Carolina

JAMES A. WILKERSON, M.D., Pathologist (retired); former Associate Professor of Pathology, The School of Medicine, The University of Alabama in Birmingham; Park City, Utah

GILBERT C. WONG, M.D., Resident, Ophthalmology, John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah

KEN ZAFREN, M.D., Emergency Physician, Alaska Native Medical Center; Clinical Assistant Professor, Division of Emergency Medicine, Stanford University Medical Center; Medical Director of the Alaska Mountain Rescue Group, Anchorage, Alaska

Buck Tilton, M.S., WEMT

At a convention in Salt Lake City, Utah, James A. Wilkerson, M.D., introduced himself and asked if I would be willing to write this foreword. I believe I responded with Are you kidding? but it could have been something equally inappropriate. I was flabbergasted. No one can appreciate what that moment meant to me, but here is my attempt at an explanation.