Marchapril 2010

Abdominal Trauma:
Also In This Issue:

Recovery in Haiti:
An Eyewitness Account
Sand Fleas
Pack Palsy
Clot- Forming Dressings
Miox
Wilderness Medicine
Newsletter
March/April 2010 Volume. 23, No. 2
whats Inside
Anywhere in the WMN, if text is

underlined and in blue,
3 Abdominal Trauma:
10 EyewitnessHaiti Part II
Illustration By T.B.R. Walsh
Feature
Departments
12 Tales of the Tapeworm: Sand Fleas
14 Common Expedition Problems: Backpack Palsy
17 Medicine Chest: New Clot-forming Dressings
19 Youre in Good Hands: MIOX
WMN Notes
21
Subscriptions & Back issuesordering
22
Back issues (complete index: 1988 to present)
23
SOLO coursesthe current course calendar
Disclaimer: The content of the Wilderness Medicine Newsletter is not a substitute for formal training or the recommendation of an expert.
The Wilderness Medicine Newsletter is intended as an informational resource only. Neither
the WMN, nor its staff, can be held liable for the practical application of any of the ideas
found herein. The staff encourages all readers to acquire as much certified training as possible and to consult their physicians for medical advice on personal health matters.
2009 TMC Books, LLC and Stonehearth Open Learning Opportunities (SOLO)
ISSN 1059-6518. All rights reserved. The newsletter may not be reproduced or
distributed without prior consent. Published six times a year.
Wilderness Medicine Newsletter, C/O TMC Books, 731 Tasker Hill Rd., Conway, NH 03818
603-447-5589 tmcbooks.com info@tmcbooks.com
Medical Editor: Frank R. Hubbell, DO Editors: S. Peter Lewis, Lee Frizzell
Departments are written by Dr. Frank Hubbell, DO, or other WMN affiliates.
Design and principle photography by S. Peter Lewis; Artwork by T.B.R. Walsh.
March/April 2010 Vol. 23, No.2
But a certain Samaritan, who was on a journey, came upon him; and
when he saw him, he felt compassion, and came to him, and bandaged
up his wounds, pouring oil and wine on them; and he put him on his
own beast, and brought him to an inn, and took care of him.
Luke 10:43 (NAS)
The Wilderness Medicine Newsletter is dedicated to all the good
Samaritans who do not hesitate to help those in need.
Abdominal Trauma:
The Facts Regarding Abdominal Trauma:
- Abdominal trauma has two primary causes: blunt trauma and penetrating trauma.
- Blunt trauma occurs from a direct blow to the abdomen, causing compression or concussion of the internal organs.
- Deceleration injuries cause a shearing or stretching of the internal supporting tissues a tug-of-war, so to speak,

between a fixed organ and the mobile support tissues.
- Blunt abdominal trauma is the leading cause of morbidity (injury) and mortality (death) in all age groups.
- The mechanism of injury (MOI) that causes blunt trauma frequently has other potentially serious injuries as well.

Rarely is blunt trauma to the abdomen an isolated injury.
- The liver and the spleen are the most frequently injured organs followed by the small and large intestine.
- 8% of trauma patients have an abdominal injury.
- 9% of abdominal trauma patients die from the abdominal injury.
- 83% of these injuries are caused by blunt trauma.
- Motor vehicle accidents account for 59% of trauma-related abdominal injuries.
- Falls from height is the second leading cause of abdominal trauma.
Anatomy of the Abdomen:
Boundaries of the abdominal

cavity the peritoneum:
Top diaphragm
Bottom pelvis
Sides muscular walls of the
flanks: obliquus externus and
internus muscles
diaphram
rib cage
liver
stomach
Front rectus abdominus and

triceps abdominus muscles
Back vertebral column and the
transverse abdominus, quadratus
lumborum, and psosas muscles
spleen
pelvis
Contents of the abdomen:
The abdomen (peritoneum) contains the organs for digestion, absorption or nutrients, excretion of wastes, reproduction, supporting structures, and blood supply. The best way to understand this array of organs is by their
function and relationship to one another and by their anatomical location by quadrant.
liver
inferior vena cava

stomach
gallbladder
aorta
spleen
pancreas
small intestine
kidneys
large intestine
ureters
bladder
Organs of Digestion and Absorption of Nutrients The Alimentary Canal

The alimentary canal begins outside the peritoneum at the mouth. Fluid and foods are consumed and chewed in
the mouth where saliva, containing digestive enzymes, is added. The pulverized food is then swallowed, and via
peristalsis travels down the esophagus. Penetrating the diaphragm, the esophagus enters the abdominal cavity, the
peritoneum, where it empties its contents into the stomach.
The stomach digests the food. Fluids and food enter the top of the stomach via the esophagus through the cardiac
sphincter and exit the bottom of the stomach into the small intestine through the pyloric valve. The stomach adds
digestive juices and hydrochloric acid to its contents and churns it into a liquid called chyme, a semifluid slurry that
is pushed through the pyloric valve into the first portion of the small intestine, the duodenum.
The small intestine consists of three sections: the duodenum, jejunum, and ileum. As the chyme is slowly pushed
through the length of the small intestine by peristalsis, the digestive process continues and the absorption of nutrients takes place.
The gallbladder and the pancreas both contribute digestive enzymes to
the contents in the duodenum to aid in digestion and absorption of fats
and nutrients.
The gallbladder is a bag-like storage container attached to the liver that
concentrates and secretes the bile when needed. When called for, the
gallbladder contracts and empties its contents, bile, into the duodenum to
aid in digestion and absorption of fats.
liver
galbladder
pancreas
The pancreas also contributes digestive enzymes along with the bile from the gallbladder. Each organ has its own
tube, the cystic duct from the gall bladder and the pancreatic duct from the pancreas. These two tubes merge to
form the common bile duct that drains these juices into the duodenum through the Ampulla of Vater.
The small intestine empties into the large intestine at the ileocecal valve. The large intestine or colon consists of the
ascending, transverse, descending, and sigmoid colon that end at the rectum. The purpose of the colon is to absorb
the water that was used in the digestive process which then concentrates the waste products of digestion into a
formed stool that minimizes the loss of water.
The liver is the biochemical factory responsible for detoxifying waste products and
toxins produced or absorbed by the body. It also produces proteins for the blood
and clotting factors and converts unconjugated bilirubin, the remnants of old or damaged red blood cells (RBCs) that have been removed and destroyed by the spleen,
into conjugated bilirubin. The unconjugated bilirubin is metabolized heme from the
hemoglobin in the RBC. It is transported to the liver where it is metabolized into
conjugated bilirubin and is stored in the gallbladder as bile to be used later in the
digestion and absorption of fats. Nothing goes to waste.
The pancreas was mentioned earlier for its contribution of its manufactured digestive enzymes. It also produces other chemicals needed for nutrition and energy production, including insulin and glucagon that are critical to the metabolism of sugar.
The spleen was mentioned earlier as the destroyer of old or damaged red blood cells (RBCs).
As blood is filtered through the spleen, the RBCs are forced through slots that are smaller than they
are. RBCs are very flexible, as they have to be able to change shape to fit into the narrow capillaries. As RBCs age, they lose their flexibility and will rupture as they move through the spleen. The
spleen will then harvest and recycle the iron from the hemoglobin molecule and convert the rest of
the heme into unconjugated bilirubin that is sent to the liver where it is processed into conjugated
bilirubin and stored in the gallbladder as bile. Again, nothing goes to waste.
The spleen is also part of the immune system, the reticuloendothelial system, and produces antibodies that are
used to combat infectious disease, parasites, and cancer.
The Organs of the Excretory System:

The excretory system removes waste products from the blood and excretes them from the body as urine. This system consists of the kidneys, ureters, bladder, and urethra.
As the blood flows through the kidneys, it is filtered, and waste products, excessive electrolytes, and excessive water
are removed, forming urine. The urine flows from the kidneys down the ureters into the bladder, where it is stored.
As the urine accumulates, the bladder will expand and eventually will fill and produce the urge to urinate. With
urination the urine is expelled out the body through the urethra. The very end, or exit, of the urethra is referred to
as the urethral meatus.
The Reproductive Organs:

The female reproductive organs are contained in the lower abdomen and consist of the uterus, fallopian tubes,
ovaries, cervix, and vagina. When the eggs are produced and released by the ovaries, they are picked up by the
fallopian tubes and transported to the uterus. If the eggs are fertilized, they will implant in the endometrial lining
of the uterus and develop into a fetus; if not, they will be sloughed along with the endometrial lining of the uterus
during menses. The sloughed tissues exit the uterus through the cervix and vagina.
The male reproductive organs consist of the penis, testes, vas deferens, seminal vesicles, and prostate gland. The
seminal vesicles and prostate are within in the peritoneum.
Supporting Structures of the Peritoneum:

All of these internal structures have to be held in place and supplied with nerves and blood vessels. This is accomplished by the mesenteries referred to as the parietal and visceral peritoneum. The parietal peritoneum lines the
walls of the peritoneum, and the visceral peritoneum surrounds and protects the internal organs. The nerves and
blood supply are within these mesenteric supporting structures.
The Circulatory System of the Peritoneal Cavity.

The aorta descends down the back of the peritoneum along the left side of the spine, and the
inferior vena cava ascends next to it on the right side of the spine. There are many large blood
vessels in the abdomen supplying blood to the lower extremities (iliac arteries and veins), the
kidneys (renal arteries and veins), the liver (hepatic artery and veins), as well as the large and
small intestines (the mesenteric arteries and veins). The peritoneal cavity and pelvis is an extremely vascular area of the body.
Within the confines of the abdomen, there are also the appendix, at the ileocecal junction (the junction of the large
and small intestines), many lymph nodes, large fat pads called the greater and lesser omentum, and of course the
navel.
Anatomy of the Peritoneum by Quadrant:

Imagining vertical and horizontal lines can help you easily divide the abdomen into 4 quadrants that intersect at the
navel: the right upper quadrant (RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and the left lower
quadrant (LLQ). Knowing the location of the anatomy within each quadrant allows the examiner to more accurately
determine the location of injury and which organ(s) is most likely to have been injured or damaged.
Left Upper Quadrant LUQ:
Right Upper Quadrant RUQ:
Spleen
Left Kidney and Ureter
Small Intestine
Large Intestine
Pancreas (midline)
Stomach (midline)
Aorta (midline)
Inferior Vena Cava (midline)
Liver
Gallbladder
Right Kidney and Ureter
Small Intestine
Large Intestine
Pancreas (midline in both the LUQ and RUQ)
Stomach (midline in both the LUQ and RUQ)
Aorta (midline)
Inferior Vena Cava (midline)
navel
Right Lower Quadrant RLQ:

Small Intestine
Large Intestine
Appendix
Right Ovary
Bladder (midline)
Left Lower Quadrant LLQ:

Small Intestine
Large Intestine and Sigmoid Colon
Left Ovary
Bladder (midline)
Uterus (midline)
Uterus (midline)
Injury patterns, bleeding, and contents are quite different between solid versus hollow organs. Solid organs tend
to bleed more aggressively, while the hollow organs contain harsh chemicals and bacteria that, when spilled into
the peritoneal space, can cause serious problems i.e. peritonitis and infection.
Hollow Organs:
Small and large intestines, bladder, gallbladder, stomach, appendix, uterus.

These organs are most prone to penetrating trauma and shearing forces.
When injured, these organs can spill their contents, which can be very irritating to the peritoneum and can cause a
significant increase in the risk of infection and/or a chemical peritonitis.
Solid Organs:
Kidneys, liver, pancreas, spleen, ovary.

These organs are most prone to blunt trauma, leading to blood loss and hypovolemic shock.
Pathophysiology of Blunt Trauma:

The MOI is either from compression (concussive) forces or decelerations forces.
The compressive or concussive forces are the result of a direct blow to the abdomen or the abdomen being forced
against a fixed object such as a seat belt which compresses underlying structures within the abdominal cavity.
Deceleration forces occur when the body is suddenly stopped as in the case of a fall from height or a head-on collision in a motor vehicle accident (MVA). The rapid deceleration causes a stretching or shearing of the organs and
tissues. This shearing occurs between heavier organs and the free-moving support tissues that help to anchor them
in place.
Both of these forces, compression and deceleration, can cause lacerations to the solid organs or ruptures to the
hollow organs.
Pathophysiology of Penetrating Trauma:

The MOI of penetrating trauma of the abdomen are generally stab wounds (a knife, a tree branch, a ski pole) and
gun shot wounds (GSWs). GSWs are high energy, high velocity injuries that have a small entrance wound and large
exit wound and an unpredictable internal injury pattern. Part of the problem with GSWs is that they do not necessarily travel in a straight line, and, therefore, it is impossible to predict the injury pattern caused by the bullet.
Stab wounds, on the other hand, usually only have an entrance wound and a very predictable injury pattern based
on location and depth of the wound.
Mechanism of Injury of Abdominal Trauma:
Blunt Trauma
Penetrating Trauma
Patient Assessment for Abdominal Trauma:
Look Inspection
Listen Auscultation
Feel Palpation
Look Inspection:
Look for external signs of injury: bruising (ecchymosis), patterns of abrasions from seat belts or lap belts. A lap belt
abrasion can indicate an underlying ruptured small intestine.
Look for specific signs of internal bleeding:
Cullens Sign is perumbilical (around the navel) ecchymosis that indicates retroperitoneal bleeding.
Grey Turners Signs is ecchymosis of flank areas, one or both, that can also indicate retroperitoneal bleeding.
Look for obvious stab wounds or gun shot wounds. Always look for exit wounds.
Look for any obvious impaled object or protruding intestines.
Look at the genitals for ecchymosis, swelling, or patterns of injury.
Listen Auscultation:
Put on your stethoscope and listen in all four quadrants for bowel sounds.
Listen for 30 seconds.
A healthy bowel is constantly in motion, thus makes gurgling sounds (borborygmi).
A sick or injured bowel will be motionless and silent.
Feel Palpate:
Palpation is an acquired skill. Gently palpate all four quadrants, one at a time. Place
one hand on the abdomenthis is the listening handand the other hand on top,
this is the hand that will be doing the work. Gently push down on the abdomen compressing the contents of the peritoneal cavity. As you gently palpate each quadrant,
think about the underlying anatomy, and ask Does this hurt? Watch the patients face
for grimacing or other reactions indicating pain or apprehension.
When examining the LUQ and RUQ, be sure to also gently palpate the 11th and 12th
ribs, the floating ribs, as they overlay and protect the contents of the upper half of
these quadrants. A fractured floating rib, crepitation of the 11th or 12th ribs, can indicate an underlying lacerated liver or spleen.
As you palpate the four quadrants for pain and tenderness also feel for guarding, rigidity, and distension. All three
can indicate peritoneal damage; internal bleeding, peritonitis, or a leaking ruptured hollow organ.
Symptoms of Abdominal Trauma:
Abdominal pain
Pain on palpation abdominal tenderness
Rigidity of the abdominal wall
Guarding
Distension
Discoloration, bruising, or ecchymosis
Patterns of injury, abrasions, or wounds
Cullens or Grey Turners Sign
Obvious external trauma, wounds, impaled objects, or protruding intestines
Blood in the urine or at the urethral meatus (end of the urethra)
Referred pain pain may be referred away from the abdomen to another part of the body, e.g. spleen refers pain
to the left shoulder
Signs and symptoms of shock:
rapid, shallow breathing
rapid, weak pulse
falling blood pressure
pale, cool, clammy skin
change in level of conscious, anxiety, feeling of doom
Treatment of Abdominal Trauma:
A, B, Cs
Treat for shock.
If suspicious of internal bleeding, gently shrink the size of the peritoneal cavity by wrapping the abdomen with two
6 elastic bandages to apply counter-pressure or indirect pressure to the areas that are bleeding internally.
MAST or PASG may also be applied to minimize internal bleeding.
Look for associated thoracic or genitourinary injuries.
Immobilize impaled objects.
Cover protruding intestines with a moist dressing and a waterproof bandage to prevent drying out or freezing.
Minimize food and water intake.
Specific Injuries:
Ruptured spleen is one of the most common organs to be injured. With a ruptured spleen there will be pain and
tenderness in the RUQ, guarding, rigidity of the abdominal wall, and referred pain to the left shoulder without any
tenderness in the shoulder.
Protruding intestines are intestines that are sticking out through a hole in the abdominal wall. They are at risk of
drying out, freezing, or having the circulation to that protruding loop of bowel being cut off by the abdominal wall
through which it protrudes. It is important to keep the loops of protruding bowel moist and warm. Cover them
with moist sterile dressings and a waterproof bandage to minimize evaporation.
Chemical peritonitis occurs when a hollow organ ruptures and spills its contents into the peritoneal cavity. These
chemicals and bacteria are very irritating to the lining of the peritoneum and will cause pain, tenderness, and
rebound tenderness (peritonitis).
Injuries to the external genitalia:

Female: labia and vulva
Male: penis, testicles, scrotum
Impact Injuries: Examine for swelling or bleeding.

Treatment: Control bleeding with direct pressure and apply cold compresses to minimize swelling.
Lacerations:
Treatment: Control bleeding with direct pressure.
Burns:
Treatment: Cool immediately to get the heat out and keep cool; apply a wet, sterile dressing.
Avulsions and Amputations:
Treatment: Control bleeding with direct pressure, and save the amputated part. Try to keep the amputated tissue
as cool as possible without freezing. This is best accomplished by placing the severed part it in a zip lock bag and
immersing it in ice water.
Impaled objects:
Treatment: Control bleeding and leave in place; stabilize with sterile dressings.
Torsion Testicle:
This usually occurs after minor trauma to the scrotum where one of the testicles has rotated. The testicle is supported by the spermatic cord from above. The cord consists of the testicular artery, vein, and vas deferens. When
the testicle rotates, it collapses this cord and shuts off its own circulation, resulting in ischemia.
Signs and Symptoms or a torsion testicle:
Sudden onset of a swollen, red, painful testicle/scrotum only on one side.
Treatment of a torsion testicle:
Apply cool compresses, use painkillers, support the testicles, and evacuate.
If the pain is caused by a torsion testicle, the pain will worsen with time and become quite severe.
The testicle may die in 24 hrs without surgical care to re-establish circulation.
Eyewitness HaitiPart II
In our last issue, Dr. Frank Hubbell shared his own experience working in Haiti to provide care and
treatment for the survivors of that countrys devastating earthquake. Continuing the trend, we received the following letter from Jonathan Eisenberg summarizing his own experience volunteering as
a relief worker in Haiti. Jon went to Haiti with Rowan Lewis, as a member of SOLOs first International
Relief Team to Haiti. They went to work with Housing Works clinics in Haiti and were able to lend a
hand at the Miami Field Hospital during their down time. We share it here just as he sent it to us.
Each and every experience SOLO providers have had in Haiti has been unique and rewarding. SOLO
is dedicated to continuing to provide assistance to the people of that island. We are thankful to all of
our volunteers who have made the trip at their own expense and given so much of their time and expertise to help. This willingness to serve is what makes SOLO instructors and students so very special.
The editors.
Measuring Success in the Face of Disaster

Measuring accomplishments on a small scale is relatively easy---you shovel a path through heavy snow or you complete a term paper. Success, or its ugly stepbrother, failure, is black or white, as clearly as a car is turned on or off.
While trying to determine the level of success I had in my month long medical mission to Haiti, I was struck with just
how many factors go into answering: How successful was I? Once a project starts to grow, so do the complexities
when measuring outcomes.
On a large scale, if someone observed my daily activities and assessed them on a macro level, I made an impact
along the lines of moving ten grains of sand in a desert. The obstacles and remedies in Haiti are simply overwhelming. To dwell on the fact that I didnt cure the entire country and that millions of people are still there without a
proper supply of food, water, and adequate shelter, was unacceptable in my mind. I would be uncomfortable
knowing that I left a country that was still in such dire need of help. So, it is imperative that I avoid the large picture.
My team consisted of two medics, a doctor, and a driver/translator. In the mornings we would be driven to a tented
clinic that operated between two mounds of rubble that were once buildings. With no identifying sign for the
clinic, people just seemed to find us. Other than a few folding chairs, a table with a notebook for registration, and
some scattered medical supplies and drugs, the clinic could have been easily overlooked.
Each day, twenty to thirty people arrived with various injuries in the hope that an American trained medical professional would be there to assess them. With the aid of our translator Sophie, a Haitian college student who had no
school to attend after the earthquake flattened it, we would take patient histories and conduct our physical exams.
Without Sophie, our hand gestures and pantomiming of ailments amounted to confused stares. Sophies command
of English and her cheery, upbeat mood helped us begin to educate patients who had no sense of what preventative health consisted of. We would also attend to a clinic approximately fifteen minutes away. Between the two clinics, my team and I were responsible for the medical care of over seventy people per day.
We dealt with a variety of somewhat mundane complaints including sore throats, headaches, and GI issues. Many of
these issues were due to the poor air quality, change in diet, sleeping outside, and lack of available purified water.
Other patients came in with more dire needs including growing infections, fractures left alone post earthquake for
fear that the fractured limb would be amputated, or a young girl with weeping wounds and an unexplained limp.
When our team knew that a specialist was needed, we made sure that the patient was seen that dayeven if it
meant driving the patient in our van to the hospital. With many miles accrued and many hours spent with each hosMarch/April 2010 Vol. 23, No.2
10
pital administrator, we were able to produce and distribute an indispensable list of contacts that clinic teams and
field hospitals around the city worked from in a more efficient manner to communicate with one another.
Once the sun hit its height and the patients in the clinics were assessed and appeased, my van would take me to
a field hospital on the outskirts of the airport. The number of patients grew, and their maladies more complex.
Medical specialists worked at a frenetic pace, all the while steering clear of the front gate and bed #1, where at
any time a motor vehicle accident, a gun shot wound, or a hurt child could come in with one of the roving foreign
ambulances that circulated around the city. Resources at the field hospital were basic but adequate for most tasks.
Traumas were brought in, stabilized, and then either wheeled into surgery, transported to an observational bed, or,
in the rare case, discharged. Even in the disaster-strewn rubble of the city, people still got into fights, drivers made
accidents, and children dismissed the rules of gravity.
Within the first ten minutes of my first day in the emergency room, paramedics wheeled in a severely injured man,
the result of a motorcycle accident. The history of the incident was unclear but with the man deteriorating before
our eyes, decisive action was taken to stabilize him. He was intubated and, with the use of a bag valve mask, we
began breathing for him before we knew if we had a ventilator. Decisions like this were a common occurrence; to
save the life before we knew if we had the resources to sustain it. Fortunately, he was stabilized and moved to the
ICU tent.
The oppressive humidity subsided just slightly at the end of the day and the streets were cleared of traffic. Homemade roadblocks were erected to keep certain roads car free so that people could sleep on them. Driving home,
an hour before the next day was about to begin, the faces of people I had helped came reeling through my mind
like a blur. Certain patients made the video in my mind pause: the post op with sepsis, the fractured leg of a four
year old, a pregnant girl with pre-eclampsia, the TB patient, the child with malariamy team helped them all. We
found a surgeon for the girl, we located a pediatric orthopedic surgeon to assess the child, another child received
his medicine, and the pregnant girl was transported to an obstetrics hospital. Every day was different but each one
brought several small victories. Amidst the heat, sweating, and endless lines of patients waiting for the ear and/or
hands of a professional, we were able to administer to those in need and make a drastic difference in the wellbeing
of many people.
I do not really know how to quantify success much like I dont know how to say how happy or pretty a person is.
The smile of a healthy girl who, hours before, was lying in a tent literally awaiting her death due to a growing infection and her grateful husband who insisted on taking my picture so that he could tell people who was responsible
for her living that is success, that is happiness, and that is truly the prettiest smile in the whole world. If only her
smile stays with me for the rest of my life, I will know that my time in Haiti was well spent.
Though reports from Haiti suggest that the job there is insurmountable, I am convinced that my energy was not
wasted. My spirit is forever tied to the people who donated funds to buy drugs and food, who sent clothing to
those whose homes were destroyed, and to the selfless medical personnel who left their comfortable surroundings
and responded to the need. Most of all, I am tied to the people of Haiti, who will continue their brave struggle in
the wake of the horrific earthquake in their homeland.
Jonathan Eisenberg of Needham, MA is a Wilderness Medicine instructor at SOLO in Conway, NH, an EMT, and
holds a BA in International Relations from Colby College in Maine. He worked for the University of Miami /Project
Medishare Field Hospital as an ER Technician and was a clinician at two primary care clinics in Port au Prince for
New York City based non profit, Housing Works. His team, consisting of Dr. Peter Sananman from Philadelphia,
PA and Rowan Lewis, SOLOs Africa Coordinator from Harare, Zimbabwe, also served as consultants for various
institutions in the city in the areas of communications, logistics, and access to advanced medical care. Jonathan starts
school this May at the University of Vermont to continue his medical studies.
11
By Frank Hubbell D.O.
illustrations by T.B.R. Walsh
Tales of the Tapewor m
Sand Fleas:
Tungiasis Tungas penetrans sand flea
In the last issue of the WMNL, a list of human ectoparasites was produced, and Myiasis, caused by the botfly was
discussed. In this issue Tungiasis, an infestation caused by the Tungas penetrans flea, will be the focus.
ECTOPALASITES:
Fly maggots:
Myiasis: Dipterous fly larva, botfly, flystrike or fly-blown. ( January/February 2010)

Tungiasis: Tungas penetrans, Chigger flea, jigger, or sand flea. (March/April 2010)
Lice: (will be discussed in the May/June 2010 issue)
Pediculosis capitus: Head lice
Pediculosis corporis: Body lice or Vagabonds Disease
Pediculosis pubis or Phthriasis pubis: Crabs or pubic lice
Mites: (will be discussed in the July/August issue)
Scabies: Sarcoptes scabiei : Itch mite, mange, crusted scabies, Norwegian scabies.
Trombiculiasis: Trombicula: chiggers, harvest mites, red bugs, scrub-itch mites
Bedbugs: (will be discussed in the September/October 2010 issue)
Cimicidae
Tungiasis:
Tungiasis is the disease/infestation caused by the parasitic flea, Tungas penetrans, also known as the sand flea, chigger flea, jigger, chigoe, nigua, pigue, and le bicho de pe. It is the smallest known flea, measuring about 1mm long.
The infestation is caused by a gravid female that penetrates the soft tissues of the skin, primarily on the hands and
feet.
Sand flea,
Tungiasis penetrans;
Also known as Sarcopsylla penetrans and
Pluex penetrans
Typical sand flea measures only 1mm across
12
Distribution:
Tungas penetrans is commonly found in tropical climates around the world, but is especially common in South and
Central America, the West Indies (all of the Caribbean Islands including Haiti), and tropical, sub-Saharan Africa.
Areas where Tungiasis penetrans are endemic
Pathophysiology:
This parasitic flea lives in dry sand and soil. Part of the life-cycle of the female is living in the soft tissues of unsuspecting, warm-blooded hosts such as dogs, mice, cows, sheep, goats, and even humans.
On humans, the flea tends to get onto our feet and crawl up under the nail beds or into the fissures that can occur
in calluses. There the female flea will burrow head first into the flesh, leaving her posterior sticking out of the skin
which allows her an area to absorb oxygen and to be able to lay her eggs and larva. This infestation can also occur
on the hands, generally on children. The process of the flea burrowing into the skin is painfulyou will know that
you are being invaded by this tiny flea. Unfortunately, since she is virtually invisible, you can not intervene and
interrupt the process.
With the head buried deep in the soft tissue, the female has access to adequate blood meals. Over the next week,
as she feeds, she grows from the size of a grain of sand to the size of a pea, or about (1cm) in diameter. She now
produces eggs and larva that drop out of the exposed hind end and onto the ground where their life-cycle continues. It is the expansion or growth of the flea that causes the pain and the possibility of secondary infections. The
pain caused by the expanding flea can be quite intense, making it difficult if not impossible to walk.
Please note for clarification: These pesky, little beasts do not like salt water; therefore, they are not found on beautiful, warm, sandy, salt water beaches. So, feel free to go barefoot and enjoy your favorite Caribbean beach.
Treatment of Tungas penetrans:
The only treatment is to sharply open the abscess caused by the parasitic flea with a scalpel and remove the flea
and all the contents of the abscessed area. Once the area has been thoroughly cleaned out, treat the wound with
iodine (Povidone or Betadine) and pack it with an antibiotic cream, ointment, or Povidone Iodine (Povidone is 2%
iodine in a water soluble gel).
Monitor the wounds several times a day for signs of infection.
Prevention of Tungiasis:
The primary prevention is to wear close-toed shoes. If you walk around barefoot or with open-toed sandals, the
gravid female flea has all the opportunity she needs to get under your nails and into your skin.
Using insecticides or insect repellents, such as permethrin, NEEM, or DEET on your shoes will help ward off these
fleas as well as other insects.
13
by Frank Hubbell,
COMMON
expedition
problems
Annoying ailments, afflictions, and mishaps. . . .
Backpack Palsy = Rucksack Paralysis = Brachial Plexopathy:

At the end of a long day of hiking with a heavy pack, you may find yourself with sore shoulders and pins and
needles sensations in your hands. This condition is a curious phenomenon that can occur while carrying a backpack
anchored to your shoulders. The weight of the pack can compress the nerves, known as the brachial plexus, which
run beneath the clavicle of your shoulders and can cause the symptoms of backpack palsy.
Brachial Plexus
Nerves
clavicle
Originating in the neck, the brachial plexus is a bundle

of nerves that crosses the shoulders, and continues
down the arms. The brachial plexus starts out as individual nerves that exit from the spinal cord through the foramina between the vertebre in the neck. These nerves
are named for the vertebre that they exit between,
and the brachial plexus originates from C5 through T2
nerve roots.
As these nerves course down the side of the neck, they
weave together to form a larger complex of nerves
that span the distance to the shoulder. The nerve roots
exiting from between the vertebre come together
to form trunks, which in turn form divisions; divisions
form cords, and cords form the branches of nerves that
extend down the length of the arm.
These roots trunks divisions cords branches that span the distance across the shoulder, comprise the
brachial plexus, and this collection is protected by the bony structure of the clavicle as well as the musculature
of the shoulder girdle. The muscles of the shoulder that cover the brachial plexus are the trapezius, steroncleidomastiod, scalenus (anterior, posterior, and medial), and supraspinatous. Together they produce a thick
pad that will hopefully protect the brachial plexus from injury.
The mechanism of injury most commonly associated with brachial plexus injuries is direct trauma, such as a
motorcycle accident where the rider falls off the bike and lands on their shoulder. But, in the case of backpackrelated injuries, it is the compression or weight of the backpack on the shoulders that causes a crush injury to
the brachial plexus. This compression injury of the nerves can cause pain, paresthesias (pins and needles sensation), numbness or even weakness to radiate down the arms.
14
Most commonly, this rucksack paralysis occurs in someone who is not used to carrying weight on their shoulders.
If they do not have enough musculature and padding to support the weight of the pack, the brachial plexus will
become compressed causing injury to the nerves and the symptoms of brachial plexopathy also known as backpack
palsy or rucksack paralysis.
Both the weight of the backpack or rucksack and the duration of carrying the weight cause the injury to the nerves.
So, the injury can be caused by carrying a heavy load, 100# or more a short distance, or a lighter weight, 40# for
example, for a long distance. In both instances a compression injury to the brachial plexus can occur.
Research done by the military has not shown any difference between using a backpack with or without a frame. A
proper-fitting backpack has much more to do with the construction of the backpack itself and how well the pack fits
the user.
A properly designed backpack includes: a well-padded waist belt, well-padded shoulder straps with a chest strap
across the front of the chest to pull the shoulder straps together, load balancing straps at the top of the shoulders,
and the ability to custom fit the back of the pack to your back by adjusting the distance between the waist belt and
the shoulder straps.
Load balancing straps
Chest strap,
or sternum
strap
Padded shoulder
straps
Padded waist belt
The military studies have also shown that the way you pack your backpack will also affect the comfort of wearing
it and the potential to sustain injury. To properly pack gear in a pack, place the heavy items high up in the back
and close to your body and light, fluffy items lower in the bottom of the pack. The pack should be kept thin, width
wise, and held securely and close to the body.
15
Symptoms of backpack palsy:
Dull ache or pain in one or both shoulders

Paresthesias, pins and needles sensation, in one or both arms and/or hands
Weakness in one or both arms and/or hands
Symptoms made worse by applying traction to the arms or pushing down on the shoulders
Treatment of backpack palsy:
Shoulder rest avoid carrying a backpack or carrying anything heavy in the hands or arms until symptoms clear.
Non Steroidal Anti-Inflammatory Drug (NSAID) therapy with Aspirin one 325mg tablet three times a day; or
Motrin(ibuprofen) three 200mg tablets three times a day; or Aleve 1 tablet twice a day. Remember all NSAIDs
should be taken with food or a meal to avoid GI upset.
Moist heat pack applied to the top and anterior surface of the affected shoulder.
Moist heat works better because it penetrates deeper into the body than dry heat.
If the condition does not improve, follow up with a health care provider, as they may have to do more sophisticated testing to determine the extent of injury. Occasionally these injuries require steroids and physical therapy.
Prevention of backpack palsy:
Wear a properly fitting backpack

with well-padded waist and shoulder
straps.
Avoid carrying too much weight
i.e. greater than 90#. (Sales people
in good outdoor shops can advise
because ultimately the suggested
maximum weight is affected by size,
weight, and fitness levels).
Strengthen the shoulder girdle
muscles by doing shoulder shrug
exercises.
Shoulder shrug exercises: Start out
with a light weight, perhaps 2# in
each hand. Do 25 shoulder shrugs per
day for 5 days in a row and then rest
2 days.
If the shoulders are feeling healthy,
increase the weight to 4# - 25 times
for 5 days with 2 days of rest. Then
increase to 6# - 25 times for 5 days
with 2 days of rest, and finally 8# - 25
times for 5 days.
The hand weights can be easily improvised using jugs of water. 1 gallon
of water weighs 8#, so start out with a
quart, (2# of water), and add a quart
each week.
Stop wearing a backpack as soon as
any of the symptoms of backpack
palsy occur.
Properly fitting backpack:
Weight packed high and close to

body, lighter gear packed low.
Correct distance
between sholder
and hip.
16
Medicine Chest
Clot-forming Dressings
The
by Frank Hubbell,
Over the past few years several new clot-forming dressings have been developed to help control severe lifethreatening bleeding. This market has been driven primarily by the military for war efforts in Iraq and Afghanistan.
There are many aspects of providing emergency care in the military setting that are quite different from those in the
civilian arena.
One of the most obvious differences is the set of massive injuries that can occur from improvised explosive devices
(IEDs). These devices can rip through vehicles producing shrapnel that can cause deep penetrating wounds and
even sever limbs. The depth of these wounds can produce life-threatening arterial bleeding which can be very hard
to control. Thus, the new dressings containing blood-clotting compounds to help rapidly form blood clots which
seals off the bleeding arteries.
Venous versus arterial bleeding a quick review of the circulatory system:
The heart is a two-sided pump. Blood returning to the heart enters the right side into the right atrium. As the heart
contracts, the blood in the right atrium is pushed through the tricuspid valve into the right ventricle. From there it
is pumped through the pulmonary valve into the vasculature of the lungs, which is referred to as the pulmonary
circulation.
In the lungs, carbon dioxide leaves
and oxygen enters the blood. The
freshly oxygenated blood now
returns to the heart and enters the
left atria. As the heart contracts, this
blood is pushed through the mitral
valve into the left ventricle and then
through the aortic valve into the
aorta.
The heartbeat, pulse, propels the
blood down the length of the aorta.
The aorta divides into smaller arteries,
then into even smaller arterioles, and
finally into the smallest vessels, the
capillaries. It is in the capillaries where
the oxygen exchange occurs, nutrients
are delivered, and carbon dioxide
and waste products are picked up.
The capillaries then merge together
to make larger venules; they merge
into veins, which merge into the vena
cava that empties the blood into the
right atrium of the heart, completing
the loop of the systemic circulation.
Aorta
Pulmonary Artery
Lung
Left Atrium
Right Atrium
Left Ventrical
Right Ventrical
17
The blood returning to the heart via the venous circulation is under very low pressure, 5 10mmHg pressure, as
opposed to blood leaving the heart and entering the arterial circulation, which is under much higher pressure
100+mmHg pressure. Because of this, arteries are buried deep under muscles, lying against the bones to protect
them from possible injury. As a result, arterial bleeding is unusual; the wound has to penetrate deeply into the
tissues to reach and injure the arteries.
Venous bleeding is under low pressure as it flows out of a wound and can be easily controlled with direct pressure and simple pressure dressings. However, arterial bleeding, being under high pressure, can squirt out of the
wound and be very difficult to control. Arterial bleeding will require several techniques in addition to direct
pressure: Applying digital pressure by plugging the hole in the artery with a finger, using a tourniquet to shut
off the blood supply to the entire limb, or using a clot-forming dressing.
Clot-forming dressings:
There are two different compounds that are currently being used to promote blood clotting in severe life-threatening arterial bleeding, Chitosan and Zeolite.
Chitosan is a polysaccharide (a polymer or chain of d-glucosamine sugars) that is found in the exoskeletons of
shrimp, lobsters, and crabs. This polymer is a natural occurring bioadhesive that rapidly binds charged surfaces
together. Thus, it promotes aggregation of platelets in the blood to clot off the bleeding arteries.
Chitosan is the active compound used in Celox and HemCon products. Celox comes as a powder that can be
put directly into wounds, or, like HemCon it comes imbedded in the dressings that are applied directly to the
wounds.
On the other hand, Zeolite is a mineral, a microporous aluminosilicate, that is extremely porous and absorbent.
It is imbedded in the dressings that are applied to the wounds. Being very absorbent the aluminosilicate quickly
forms stable blood colts in the bleeding arteries. Zeolite is used in QuikClot brand hemostatic dressings.
Studies have shown that both of these products are very effective and are used by the US military. The only down
side of Chitosan-based products is that they have to be monitored over time as the clots that form at the site of
the injury will begin to deteriorate after about 2 hours and bleeding can resume. Neither of these products is
dangerous to the human body.
In the typical, everyday urban EMS situations, these clot-forming dressings are rarely needed as arterial bleeding
is rarely encountered and venous bleeding can always be controlled with direct pressure and pressure bandages.
But in long-term wound care outside the Golden Hour or whenever arterial bleeding occurs, these products can
not only be life-saving, but they can prevent the need to use a tourniquet.
18
Youre in Good Hands

practical treatments for
backcountry medical emergencies
MIOX Water Purifier

As we all know, the ability to produce potable water is
extremely important for the outdoor enthusiast, the international traveler, and disaster response teams. There
are a variety of techniques that can all be successfully
used. In this issue of the WMNL, we will discuss the use
of the MIOX Purifier system and hypochlorite solution.
Different techniques for making potable water are:
Bringing the water to a rolling boil 212F or 100C
Adding chemicals iodine and chlorine
Using of filters with the addition of chemicals
The Steripen and UVC light
Direct sunlight UVA light
MIOX Purifier and hypochlorite
The MIOX Purifier:
The MIOX Purifier, manufactured by Mountain Safety Research (MSR), is a readily available product at outdoor gear
retailers as well as on-line suppliers and costs about $140.
How does it work?
MIOX works by making a strong solution of chlorine, hypochlorous acid, and hypochlorite. Using ordinary salt, fresh
water, and an electrical current, it creates a small amount of oxidant solution consisting of chlorine and hypochlorous
acid. This oxidant solution is then added to your drinking water to kill any microorganisms present in the water.
To quote MSR directly:
Electrolysis breaks the chemical bonds of the salt water, or brine (NaCl + H2O), and stimulates chemical reactions,
creating primarily chlorine (Cl2 + HOCl + OCl-). Based on microbiological testing, it is likely that other chloroxygen
compounds more potent than chlorine are also being created. With current technology, we have been unable to
identify these other compounds; therefore, we can claim only that we make a strong chlorine/hypochlorous acid solution. We know, however, that the MIOX solution effectively inactivates cryptosporidia, while chlorine does not
even after days of exposure. The bubbles you see while the purifier is operating are hydrogen ions being freed.
MIOX Specifications:
The MIOX kit contains:
MIOX purifier that is about 7 long and 1 in diameter; it weighs 3.5 oz. (99g)
43g /1.5 oz. of salt, enough to treat 200+ liters or
53+ gallons of water
2 lithium CR123 batteries
50 test strips in a sealed container
Storage sack
19
How do you operate it?
Prepare the purifier:

Remove the battery cap and properly install the 2 batteries and replace the cap.
Remove the salt-chamber cap and fill the salt chamber 2/3 full with salt. Replace the cap and screw it down snugly.
The salt does not have to be replaced or replenished after every use. The salt chamber holds enough salt for several gallons of water. Check it and refill as necessary.
You are now ready to make chlorine.
1. Remove the entire salt chamber.
2. Fill the cell area with water (the cell area holds about 1ml (1/4 tsp.) of water).
3. Reattach the salt chamber.
4. Gently shake or invert the Purifier 10 times. This allows the water to flow up into the salt chamber and make a
brine solution.
5. Remove the salt chamber without spilling the brine solution.
6. Click the Purifiers activation button.
1 click for liter
2 clicks for 1 liter
3 clicks for 2 liters
4 clicks for 1 gallon
7. LEDs on the MIOX will tell you what it is doing.
8. When the green run light turns off, the solution is ready to use.
9. Pour the contents of the chlorine solution into the water.
10. Cap the water bottle and shake to mix the solution and allow it to stand the appropriate amount of time.
11. After 10 15 minutes check the water with the supplied test strips.
12. Pour a small amount of the treated water into the lid and threads before recapping.
More detailed instructions are included with the kit.
Required treatment time with 4ppm (OK) oxidant level:
Viruses:
15 minutes
Bacteria:
15 minutes
Protozoa:
30 minutes (giardia)
Cryptosporidium: 4 hours
The pros:
It was a very easy system to learn to use properly.

It is very effective against all microorganisms including cryptosporidium. But, you have to remember that if you are
trying to kill cryptosporidium, you have to allow the water to stand for at least 4 hours. Cyrptosporidium is only
going to cause illness in immunocompromised individuals.
The components to operate the system are readily available salt, water, and the camera batteries.
The cons:
The fact that it needs batteries does mean that you have to plan for the day. Once you have purified 50+ gallons
of water, then you will have to replace the batteries and get more salt. But, other than that, there really arent any
other issues.
Impression:
It is a very effective system that truly works. Easy to use, compact, light, and durable, it is affordable and effective.
20
Wilderness Medicine
Newsletter
September/October 2009 Volume. 22, No. 5
Subscription
Information
back issues
Each issue of the newsletter is uploaded to a protected area on our website, (www.tmcbooks.com),
as a PDF file. Each subscriber is issued a login name
and a password and can visit the website anytime
to download issues. Subscriptions can be ordered
and paid for online from our website via credit
card, or you can fill out the form below and mail us
a check. (Please make the check out to TMC Books
and put WMN on the memo line.)
The subscription rates are as follows:
One-year (6 issues) $15
Two-years (12 issues) $25
Three-years (18 issues) $30
Overseas subscriptions must be in US funds.
New subscription &

renewal form
Name
Please Note: Each issue of the WMN is available

for download as a PDF file for 120 days. At any given time, both the current issue, and the issue prior
to it, are typically available. After 120 days, each
issue is disabled for download and designated as
a back issuealthough it will remain on the site as
a reference. Back issues may be ordered using the
form below. Please send a check with your order to
the address above.
PRICES
Paper issues: May 1988 through December 2001
PDF issues (they come on a CD): 2002 to present
You may mix paper and PDF issues.
Prices include shipping.
Address
Most Important: please print e-mail as clearly as possible
State
Any 5 issues $15.00
CD special (02 08) $65
Any 10 issues $25.00
Zip
Any 25 issues $50.00
al i s a
ci
eat
E-mail
full set (140 issues) $165
gr
City
Any 1 issue $4
c d sp
e
The newsletter is an online journal published six

times each year.
Back issues of the Wilderness Medicine Newsletter

are available. Please specify issue(s) and send your
request and payment to:
TMC Books, 731 Tasker Hill Rd.,
Conway, NH 03818
Please circle the issues you want on the
back-issue index on the next page and mark the
correct quantity line below.
deal!
Total amount due

Name
Address
City
E-mail
By supporting this electronic magazine, you are helping to preserve our homes. Thank you.
The Wilderness Medicine Newsletter is produced using organic, soy-based electrons.
State
Zip
Most Important: please print e-mail as clearly as possible
Phone
21
Complete WMN topical index: May 1988February 2010

1
May 1988
Head Injury, Headache
2
June 1988
Feet, Sprains & Strains, Blisters
3
July 1988
Heat Injury, Heat Cramps
4
August 1988 Lyme Disease, Insect Bites
5
September 1988 Wound Management, Wound Infection, Giardia
6
October 1988
Hypothermia, Immersion Foot
7
November 1988
Legal Aspects, Major Wound Care, Epistaxis
8
December 1988
Hx of Wild Med, Snakebite, Hyperventilation
9
January 1989 Frostbite, Cervical Spine
10
February 1989
Altitude Illness, Yeast Infections, Spinal Assessment
11
March 1989
Neck Pain, Altitude, Rashes, Poisoning
12
April 1989
Dental Emergencies, Poisoning Chart, Otitis Externa
13
May 1989
Backache, Poisoning, Heartburn
14
June 1989
Rabies, Cocaine, Anaphylaxis
15
July 1989
Dysbarism, Lyme, Sunburn
16
August 1989 Lightning, Common Cold, Altered LOC
17
September 1989 Malaria, Healing, Fractured Clavicle, Asthma, Peter Hackett, MD
18
October 1989
Feet, Fractures, Mushrooms
19
Nov/Dec 1989
Toxic Shock Syndrome, Spider Bites, Femur, Frostbite
20
Jan/Feb 1990 Optic Injuries, Pain, Rescue Tobaggan, Hand Injuries
21
Mar/Apr 1990
Naegleria, Panic, Hypothermia, Red Tide, Cold Sores
22
May/June 1990
Insects, Allergies, Water, Fishhooks, Water Disinfection
23
July/Aug 1990
Violent Behavior, SCIM, SOAPnote, Poison Ivy, Patellofemoral
24
Sept/Oct 1990
Immersion, Bears, Hearing, Carpal Tunnel, Femur
25
Nov/Dec 1990
Tendonitis. Tetanus, Asthma, Hobo Spider, Shin Splints
Vol. 2, 1 Jan/Feb 1991
Fever, Hypothermia, Leptospirosis
2
Mar/Apr 1991
Fractures, Hypothermia,
3
May/June 1991
Infectious Disease, Hypothermia, Amputation
4
July/Aug 1991
Dehydration, Dogs, Leeches, Facial fractures
5
Sept/Oct 1991
SAR Basics, Cervical Spine, Raynauds Syndrome
6
Nov/Dec 1991
BP, Hand Injuries, Arthritis
HBV, Socks, Snakebite
2
Mar/Apr 1992
Med Hx, Fibromyalgia, Appendicitis
3
May/June 1992
Drugs, Activated Charcoal, Vapor Barriers
4
July/Aug 1992
Ankle Injuries, Knee Injuries, Vapor Barriers
5
Sept/Oct 1992
Psych Assessment, NOLS
6
Nov/Dec 1992
Deep Wounds, Burn Care
Vol 4, 1 Jan/Feb 1993
Anaphylaxis, Puma Attacks
2
Mar/Apr 1993
Helicopter, Ailing Nails, Insects
3
May/June 1993
Diving Emergencies, Suicide, UTI
4
July/Aug 1993
Water Disinfection, Cryptosporidium, Hantavirus, Hygiene
5
Sept/Oct 1993
Book Review Issue
6
Nov/Dec 1993
Asthma, Seizures, Diabetes
Legal Issues
2
Mar/Apr 1994
Wild Pediatrics
3
May/June 1994
Zoonoses
4
July/Aug 1994
Ozone & UV light
5
Sept/Oct 1994
The 5 Commandments of First Aid Kits
6
Nov/Dec 1994
Principles of Wild EMS, Newsletter moves back to SOLO
Can I Do That, Legally?, Cellulitis, William Forgey, MD
2
Mar/Apr 1995
Outdoor LeadershipPast and Present, Diamox
3
May/June 1995
Parasitology, HAV, Warren Bowman, MD
4
July/Aug 1995
Wilderness Pediatrics, Allerigies
5
Sept/Oct 1995
Hypothermia, Keith Conover, MD
6
Nov/Dec 1995
Chest Injuries, Cardiac Risk, Anaphylaxis, Frank Hubbell, DO
Hello, 911? Murray Hamlet, DVM
2
Mar/Apr 1996
Eating disorders, Bill Herring, MD
3
May/June 1996
Immersion Foot, Robert Rose, MD
4
July/Aug 1996
Musculoskeletal system I
5
Sept/Oct 1996
Lightning
6
Nov/Dec 1996
Potpourri: Frostbite, chilblains, Avalanche, David Kuhns, PAC
Musculoskeletal system II
2
Mar/Apr 1997
Drowning, Ask the Experts
3
May/June 1997
Rabies, Ask the Experts
4
Jul/Aug 1997 Womens Health Issues, Ask the Experts
5
Sept/Oct 1997
Water, Water, EverywhereDeath in the Backcountry
6
Nov/Dec 1997
Medecine Sans Frontieres
Avalanche Awareness
2
Mar/Apr 1998
ALS in the Backcountry
3
May/June 1998
The Charcoal Vest hypothermia
4
July/Aug 1998
ISMM Case, Summer Review Heat Injuries
5
Sept/Oct 1998
Whats Your Position GPS, Trenchfoot
6
Nov/Dec 1998
Gender Specific Emergencies, Hypothermia
Vol. 10, 1 Jan/Feb 1999
Tendonitis, Musculoskeletal problems
2
Mar/Apr 1999
Anaphylaxis, Clearing the Cervical spine
3
May/June 1999
Wild Critical Incident, Kayaking injuries
4
July/Aug 1999
Children in the Mountains
5
Sept/Oct 1999
Oh, My Aching Feet, Joy of Socks,
6
Nov/Dec 1999
Breathing Hard in the Backcountry, Pre-Existing Conditions
Vol. 11, 1 Jan/Feb 2000
Lions & Tigers & Bears, Oh My,
2
Mar/Apr 2000
Unraveling Abdominal Pain, Oral fluids, cave rescue
3
May/June 2000
Sunscreen Controversy, Dehydration & Heat Injury
4
July/Aug 2000
Leadership in Prevention, Lost Proofing
5
Sept/Oct 2000
Stonefish, Sea snakes, & Jellyfish, Shark bites
6
Nov/Dec 2000
Got the Travel Bug, Bugs in Bed
Vol. 12, 1 Jan/Feb 2001
Have You Ever Wondered Why?
2
Mar/Apr 2001
Dont Blame Montezuma
3
July/Aug 2001
Contact Dermatitis
4
July/Aug 2001
Diabetes in the Wilderness, Answers to Common Wild ?
5
Sept/Oct 2001
Wilderness Rescue in the Winter Environment
6
Nov/Dec 2001
Survey of Backcountry Drugs
Vol. 13, 1 Jan/Feb 2002
Brief History of Wilderness Med Outside the Golden Hour
2
Mar/Apr 2002
Managing a Backcountry Fatality
3
May/June 2002
The World of Infectious Disease
4
July/Aug 2002
Preventing Infectious Disease, Schistosomiasis
5
Sept/Oct 2002
Cardiac Disease, Aspirin, West Nile Virus
6
Nov/Dec 2002
Risk Management Briefing, Psychotropics, smallpox
Vol. 14, 1 Jan/Feb 2003
Weather, Psychotropics, Giardia
2
Mar/Apr 2003
Musculoskeletal Trauma I, Psychotropics part 2
3
May/June 2003
Musculoskeletal Trauma II
4
July/Aug 2003
Lightning, Beauty & the Beast
5
Sept/Oct 2003
Musculoskeletal Trauma III, Pain Control
6
Nov/Dec 2003
The Performance Triad, H2O, Water purification
Vol. 15, 1 Jan/Feb 2004
When Jack Frost Bites, Mike Lynn
2
Mar/Apr 2004
Changes in Level of Consciousness, part 1
3
May/June 2004
Changes in Level of Consciousness, part 2
4
July/Aug 2004
The Heart of the Problem, Acute MI, Giant Hogweed
5
Sept/Oct 2004
Dental Emergencies, STARI, dislocated patella
6
Nov/Dec 2004
Frozen Mythbusters
Vol. 16, 1 Jan/Feb 2005 Non-Freezing Cold Injuries, Free Radicals
2
March/April 2005 Self-Preservation Disaster Response
3
May/June 2005
Heat-Related illness
4
July/Aug 2005
Malaria
5
Sept/Oct 2005
Eye Injuries
6
Nov/Dec 2005
Burns
Vol. 19, 1 Jan/Feb 2006
Soft Tissue Injuries: Part 1
2
March/April 2006 Soft Tissue Injuries: Part 2
3
May/June 2006
First Aid Kits, Crush Injuries
4
July/August 2006 Poisonous Pearls (of wisdom)
5
Sept/Oct 2006
SNAP! Crackle Pop: Orthopedic Emergencies
6
Nov/Dec 2006
High Altitude Illness
Vol. 20, 1 Jan/Feb 2007
20 Years of Wilderness Medicinea retrospective
2
Mar/April 2007
The First Five Minutesthe Patient Assessment System
3
May/June 2007
The First Five MinutesCritical Care
4
July August 2007 BarotraumaDeep Trouble
5
Sept/Oct 2007
AllergiesRunny Nose to Anaphylaxis
6
Nov/Dec 2007
The Rist of Caring
Vol. 21, 1 Jan/Feb 2008
Disaster, TB, Nausea, Tib-Fib splint, WMN Extreme Makeover
2
March/April 2008 Navigation, Dengue, Constipation, Laxatives, Traction Splint
3
May/June 2008
Diabetes, Yellow Fever, Fever, Pelvic Sling
4
July/August 2008 Facial Trauma, Water-Borne Disease, Spine, Water, Pain, Blisters
5
Sept/Oct 2008
Shortness of Breath, giardiasis, inhalers, eye abrasions/impalements
6
Nov/Dec 2008
Respiratory trauma, cholera, fishhooks, bugs in ear, antihistamines
Vol. 22, 1 Jan/ Feb 2009
A Winter Primer
2
March/April 2009 Summer Primer, influenza, rhinitis, dermatology, boot bash, Africa Prt I
3
May /June 2009
Summer Primer, influenza, rhinitis, dermatology, boot bash, Africa Prt II
4
July/August 2009 Principles of Long-Term Patient Care-Part I
5
Sept/Oct 2009
Principles of Long-Term Patent Care -Part II
6
Nov/Dec
Special Haiti edition: Disaster Management Revisited
Vol. 23, 1 Jan/Feb 2010
Celiac Disease
2
March/April
Abdominal Trauma
To order back issues, from

a single issue, to a great CD
deal, to a full set (140 issues),
please see the order form on
the previous page. CD special (02 09) $65
NOTE: Standard of care changes over time. Treatment deemed appropriate in years past may not be appropriate today.
Paper issues are available for May 1988 through December 2001 2002 and beyond are available on CD only see prices on the subscription page
22
SOLO Wilderness First Aid & Medical Training Options

START DATE END DATE
CLASS
04/19/10
04/24/10
04/24/10
04/24/10
04/24/10
04/24/10
04/24/10
04/24/10
04/24/10
04/29/10
05/01/10
05/01/10
05/01/10
05/01/10
05/01/10
05/01/10
05/01/10
05/01/10
05/01/10
05/05/10
05/08/10
05/09/10
05/10/10
05/10/10
05/10/10
05/10/10
05/10/10
05/11/10
05/15/10
05/15/10
05/15/10
05/15/10
05/15/10
05/15/10
05/15/10
05/15/10
05/15/10
05/15/10
05/15/10
05/16/10
05/17/10
05/17/10
05/17/10
05/17/10
05/17/10
05/17/10
05/17/10
05/17/10
05/18/10
05/18/10
05/18/10
05/18/10
05/19/10
05/19/10
05/22/10
05/22/10
05/22/10
05/22/10
05/22/10
WEMT PART 2
WFA
WFA
WFA
WFA
WFA
WFA
WFA
WFA
WFA
CPR
WFA
WFA
AWFA (PT 2)
WFA & CPR
WFA
WFA
WFR INTENSIVE
WFR
WEMT MODULE
WFA
WFR REVIEW
WFA
WEMT MODULE
WFR
WFR
WFR
WFR
WFA
WFA
WFA
WFR REVIEW
WFA
WFA
WFA
WFA
WFR INTENSIVE
WFR
WFR INTENSIVE
WFA
WFA
AWFA
WFR INTENSIVE
WFR INTENSIVE
WFR INTENSIVE
WFR
WFR
WFR
WFA
WFR INTENSIVE
WFR
WEMT
WFR
WFR
CPR
WFA
WFA
WFR REVIEW
WFA
04/30/10
04/24/10
04/25/10
04/25/10
04/25/10
04/25/10
04/25/10
04/25/10
04/25/10
04/30/10
05/01/10
05/02/10
05/02/10
05/02/10
05/02/10
05/02/10
05/02/10
05/08/10
05/09/10
05/09/10
05/09/10
05/10/10
05/11/10
05/14/10
05/18/10
05/19/10
05/21/10
05/20/10
05/16/10
05/16/10
05/16/10
05/16/10
05/16/10
05/16/10
05/16/10
05/16/10
05/22/10
05/22/10
05/22/10
05/17/10
05/18/10
05/21/10
05/23/10
05/24/10
05/24/10
05/25/10
05/25/10
05/26/10
05/19/10
05/24/10
05/28/10
06/11/10
05/27/10
05/28/10
05/22/10
05/23/10
05/23/10
05/23/10
05/23/10
LOCATION
CONTACT
SOLO, CONWAY, NH
603-447-6711
AMC - NARRAGANSETT, RI
401-351-2234
BATES COLLEGE, ME
adengler@bates.edu
BSA - NASHUA VALLEY COUNCIL, MA
978-562-7620
CENTRAL WYOMING COLLEGE, WY
307-733-7425
HARVARD OUTDOOR CLUB, MA
gold-parker12@college.harvard.edu
NDAKINNA EDUCATION CENTER, NY
518-583-9958
UNH OUTING CLUB, NH
tmn24@unh.edu
UNIVERSITY OF FLORIDA, FL
352-273-4543
MERCK FOREST & FARMLAND CTR., VT
802-394-7836
NANTAHALA OUTDOOR CENTER, NC
828-488-7213
AMC - BOSTON 40+ CHAPTER, MA
617-233-6423
AMC - MAINE CHAPTER, ME
207-778-0801
AMC - WOODSTOCK, NH
603-726-3553
DARTMOUTH OUTING CLUB, NH
603-646-2428
GREEN MOUNTAIN CLUB, HQ WATERBURY CTR., VT
802-244-7037
OUTDOOR ADVENTURE SOCAIL CLUB, VA
434-760-4453
BLUE SKY WILDERNESS, SANTA CRUZ ISLAND, CA
805-320-7602
CAMP MCDOWELL, NAUVOO, GA
770-992-2055 x 222
518-583-9958
GERRY BRACHE, ORLAND, ME
207-469-0059
WEST VIRGINIA UNIV, WV
304-293-2292
RFK CHILDRENS ACTION CORP, MA
978-365-2803
SOLO, CONWAY, NH
603-447-6711
OUTWARD BOUND, INC., ME
800-341-1744
UNITY COLLEGE, ME
207-948-3131
MAINE BOUND ADVENTURE CTR., ME
207-581-1752
WEST VIRGINIA UNIV, WV
304-293-2292
ALPINE ENDEAVORS, NY
845-658-3094
CAMP POTAWOTAMI, IN
260-704-4360
CHATTAHOOCHE NATURE CENTER, GA
770-992-2055 x 222
HULBERT OUTDOOR CENTER, VT
802-333-3405
OUTDOOR WISCONSIN LEADERSHIP SCHOOL (OWLS), WI 262-245-5161
SOLO, CONWAY, NH
603-447-6711
ST. VINCENT HOSPITAL, MA
508-363-6077
352-273-4543
BOUNDLESS ADVENTURES - Unicoi State Park, GA
904-548-4490
BOUNDLESS ADVENTURES-UNICOI STATE PARK, GA
904-548-4490
307-733-7425
HARVARD FOP, MA
978-846-2949
MASS AUDUBON, MA
781-259-9500
FALLING CREEK CAMP - NANTAHALA, NC
800-232-7238
PAUL SMITHS COLLEGE, NY
518-327-6389
HAMPSHIRE COLLEGE, MA
413-559-5536
HAMPSHIRE COLLEGE, MA
413-559-5536
OUTDOOR WISCONSIN LEADERSHIP SCHOOL (OWLS), WI 262-245-5161
UNIVERSITY OF ALABAMA, AL
205-348-4701
802-333-3405
HARVARD FOP, MA
978-846-2949
CAMP MINIWANCA, MI
231-861-2262
SOLO, CONWAY, NH
603-447-6711
SOLO, CONWAY, NH
603-447-6711
JAMES MADISON UNIVERSITY, VA
540-568-8713
UNIVERSITY OF MISSOURI, MO
573-884-1764
828-488-7213
ATC-MARO, PA
717-258-5771
CAMP CHINGACHGOOK, NY
518-656-9462
CHATTAHOOCHE NATURE CENTER, GA
770-992-2055 x 222
CLEVELAND METROPARKS, OH
216-341-1704
KEY: WFA: Wilderness First Aid AWFA: Advanced Wilderness First Aid WEMT: Wilderness Emergency Medical Technician EMT/RTP: WEMT Refresher Training
WEMT Module: certifies street EMTs to the WEMT level Advanced WEMT Module: 5 days, SAR & Technical Rescue emphasis WFR: Wilderness First Responder
WFR Intensive: fewer days, more hours/day WFR Review: two-day WFR review Mission Medicine: medicine for missionaries Wild Day: 1-day wilderness WEMT recert
International Medicine: International Travel Medicine at WFA, WFR, & WEMT levels
FOR A COMPLETE LISTING OF SOLO COURSES, PLEASE VISIT WWW.SOLOSCHOOLS.COM
23

START DATE END DATE
CLASS
05/22/10
05/22/10
05/22/10
05/22/10
05/24/10
05/26/10
05/27/10
05/29/10
05/29/10
05/29/10
05/29/10
05/29/10
05/29/10
05/29/10
05/31/10
06/01/10
06/03/10
06/04/10
06/05/10
06/05/10
06/05/10
06/05/10
06/07/10
06/07/10
06/09/10
06/10/10
06/11/10
06/11/10
06/12/10
06/12/10
06/12/10
06/12/10
06/13/10
06/13/10
06/13/10
06/14/10
06/14/10
06/15/10
06/16/10
06/16/10
06/16/10
06/18/10
06/19/10
06/19/10
06/19/10
06/21/10
06/22/10
06/27/10
07/06/10
07/09/10
07/10/10
07/13/10
07/13/10
07/17/10
07/26/10
WFA
WFA
WFA
WFA
WEMT MODULE
WFR
WFA
WFA
WFA
WFA
WFA
WFR REVIEW
WFA & WFR RECERT
WFA
WEMT PART 2
WFR INTENSIVE
WFA
WFA
WFA
WFA
WFR REVIEW & CPR
WFR
CPR
WFA
WFR REVIEW
WFA & CPR
WFA
WFA
WFA
WFR REVIEW
WFA
WFR INTENSIVE
WFA
WFA & CPR
WFR Intensive
WFA
WFA & CPR
WFA
CPR
WFA
WFA
WFA & CPR
CPR
WFA
WFA
WFA & CPR
WFR INTENSIVE
ADVANCED WEMT MODULE
WEMT/INTL MODULE
WFR
WFA
WFR
WEMT
WFR REVIEW
WEMT PART 2
05/23/10
05/23/10
05/23/10
05/23/10
05/28/10
06/03/10
05/28/10
05/30/10
05/30/10
05/30/10
05/30/10
05/30/10
05/30/10
05/30/10
06/11/10
06/08/10
06/04/10
06/05/10
06/06/10
06/06/10
06/06/10
06/13/10
06/07/10
06/08/10
06/10/10
06/12/10
06/12/10
06/12/10
06/13/10
06/13/10
06/13/10
06/19/10
06/14/10
06/15/10
06/20/10
06/15/10
06/15/10
06/16/10
06/16/10
06/17/10
06/18/10
06/20/10
06/19/10
06/20/10
06/20/10
06/23/10
06/30/10
07/01/10
07/10/10
07/18/10
07/11/10
07/23/10
08/06/10
07/18/10
08/06/10
LOCATION
ELIZABETH STONE HOUSE, MA
MOHICAN OUTDOOR CTR., NJ
NOBLE VIEW OUTDOOR CENTER, MA
MERCERSBURG ACADEMY, PA
MERROWVISTA EDUCATION CENTER, NH
ADVENTURE LINKS, VA
INDIANA UNIVERSITY OUTDOOR ADVENTURE, IN
NEW CANAAN NATURE CENTER, CT
OUTWARD BOUND -MAINE SEA PROGRAM, ME
THOMPSON ISLAND OUTWARD BOUND, MA
UNIVERSITY OF MISSOURI, MO
SOLO, CONWAY, NH
FARM & WILDERNESS, VT
YMCA - SOUTH MTN., PA
WILDERNESS ADVENTURES @ EAGLE LANDING, VA
AMC - BERKSHIRES, SOUTH EGREMONT, MA
CAMP CHINGACHGOOK, NY
CAMP KAYBEYUN, ALTON BAY, NH
SPRUCE LAKE RETREAT CENTER, PA
WOODBERRY FOREST SCHOOL, VA
SARGENT CENTER, NH
CAMP LAUREL, ME
CAMP LAUREL SOUTH, ME
CAMP AGAWAM, ME
WAYNE STATE UNIVERSITY, DETROIT, MI
SOLO, CONWAY, NH
CAMP ARCADIA, ME
CAMP MINIWANCA, MI
LAWRENCE UNIVERSITY, WI
CAMP BROOKWOODS, NH
NORTH COUNTRY CAMPS, NY
YMCA - BECKET-CHIMNEY, MA
CAMP SLOANE YMCA, CT
MERROWVISTA EDUCATION CENTER, NH
GREEN MOUNTAIN CLUB, HQ WATERBURY CTR., VT
FOX KITS WILDERNESS SURVIVAL SCHOOL, TN
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
CONTACT
617-864-2880
908-362-5670
518-583-9958
413-562-6792
717-328-1499
603-539-6607
307-733-7425
800-877-0954
802-333-3405
812-332-4102
203-966-9577
207-230-5605
617-328-3900
573-884-1764
603-447-6711
802-422-3761
610-670-5010
800-782-0779
413-528-8003
518-656-9462
603-746-3485
603-746-3485
828-488-7213
570-595-7505
434-924-7834
kbied@naturesclassroom.org
203-227-8866
207-627-4334
207-892-1200
352-273-4543
313-577-2348
603-447-6711
604-720-2692
231-861-2262
920-585-2320
603-875-3600
603-746-3485
518-834-5152
828-488-7213
413-623-8991
860-435-2557
603-539-6607
828-488-7213
207-469-0059
802-244-7037
731-610-8020
603-447-6711
603-447-6711
603-447-6711
352-273-4543
603-447-6711
603-447-6711
603-447-6711
603-447-6711
603-447-6711
24

START DATE END DATE
07/31/10
08/07/10
08/07/10
08/07/10
08/14/10
08/15/10
08/17/10
08/21/10
08/22/10
08/23/10
08/28/10
08/28/10
08/30/10
09/04/10
09/07/10
09/07/10
09/16/10
09/20/10
09/25/10
09/27/10
10/02/10
10/02/10
10/12/10
10/12/10
10/16/10
10/23/10
10/23/10
10/24/10
10/25/10
10/25/10
11/06/10
11/06/10
11/06/10
11/08/10
11/08/10
11/13/10
11/15/10
11/15/10
11/20/10
11/20/10
11/20/10
11/20/10
11/20/10
11/20/10
11/22/10
11/29/10
12/03/10
12/11/10
12/11/10
12/18/10
12/28/10
12/28/10
01/07/11
01/10/11
01/15/11
04/24/11
08/01/10
08/08/10
08/08/10
08/14/10
08/15/10
08/22/10
08/23/10
08/22/10
08/30/10
08/25/10
08/29/10
08/29/10
09/03/10
09/14/10
09/17/10
10/01/10
09/18/10
10/01/10
09/26/10
10/06/10
10/03/10
10/03/10
10/22/10
11/05/10
10/17/10
10/24/10
10/24/10
10/31/10
11/05/10
11/05/10
11/07/10
11/07/10
11/13/10
11/10/10
11/12/10
11/14/10
11/26/10
12/10/10
11/21/10
11/21/10
11/21/10
11/21/10
11/21/10
11/23/10
11/23/10
12/10/10
12/10/10
12/18/10
12/19/10
12/19/10
01/07/11
01/21/11
01/14/11
01/21/11
01/16/11
04/25/11
CLASS
WFA
WFA
WFA
WFR INTENSIVE
WFR REVIEW & CPR
WFR INTENSIVE
WFR INTENSIVE
WFA
WFR
WFA & CPR
WFA
WFA & CPR
WEMT MODULE
WFR
WFR
WEMT
WFR REVIEW & CPR
WEMT PART 2
WFA
WFR
WFA
WFA
WFR
WEMT
WFA
WFR REVIEW & CPR
WFA
WFR INTENSIVE
WFR
WEMT PART 2
WFA
WFA
WFR INTENSIVE
WFA & CPR
WEMT MODULE
WFA
WFR
WEMT
WFA
SEARCH & RESCUE
WFR REVIEW
WFA
WFA
AWFA
AWFA (PT 2)
WEMT PART 2
WEMT MODULE
WFR INTENSIVE
WFR
WFA
WFR
WEMT
WFR INTENSIVE
WEMT PART 2
WFR REVIEW
WFA
LOCATION

AMC - GORHAM., NH
SOLO, CONWAY, NH
APEX MOUNTAIN SCHOOL, CO
SOLO, CONWAY, NH
MOUNTAIN INSTITUTE, WV
GREEN MOUNTAIN CLUB, VT
SOLO, CONWAY, NH
TUTUACA MOUNTAIN SCHOOL, MEX
SOLO, CONWAY, NH
SOLO, CONWAY, NH
TUTUACA MOUNTAIN SCHOOL, MEX
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
BSA - ATLANTA AREA COUNCIL, GA
AMC - PINKHAM, HIGHLAND CTR., NH
SOLO, CONWAY, NH
AMC - PINKHAM, NH
WATERVILLE VALLEY ATHLETIC & IMPROVEMENT, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, VT
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SOLO, CONWAY, NH
SLIPPERY ROCK UNIVERSITY, PA
SOLO, CONWAY, NH
SLIPPERY ROCK UNIVERSITY, PA
THE NORTHWEST PASSAGE, IL
CONTACT
207-469-0059
603-466-2721
352-273-4543
603-447-6711
888-686-7685
888-686-7685
603-447-6711
845-658-3094
304-567-2632
731-610-8020
207-469-0059
802-244-7037
603-447-6711
307-699-4997
603-447-6711
603-447-6711
307-699-4997
603-447-6711
603-447-6711
731-610-8020
207-469-0059
812-332-4102
603-447-6711
603-447-6711
603-447-6711
888-686-7685
706-342-1234
888-686-7685
603-466-2727
603-447-6711
603-466-2721
603-236-4700
603-447-6711
731-610-8020
603-447-6711
812-332-4102
603-447-6711
603-447-6711
845-658-3094
802-333-3405
802-333-3405
802-333-3405
603-447-6711
802-333-3405
802-333-3405
603-447-6711
802-333-3405
603-447-6711
802-333-3405
603-447-6711
603-447-6711
603-447-6711
724-738-2883
603-447-6711
724-738-2883
800-732-7328
25

Marchapril 2010

Transféré par

Informations du document

Description originale:

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Marchapril 2010

Transféré par

Droits d'auteur :

Formats disponibles

Abdominal Trauma:

Also In This Issue:

March/April 2010 Volume. 23, No. 2

Anywhere in the WMN, if text is

Illustration By T.B.R. Walsh

Subscriptions & Back issuesordering

Back issues (complete index: 1988 to present)

SOLO coursesthe current course calendar

March/April 2010 Vol. 23, No.2

Anatomy of the Abdomen:

Boundaries of the abdominal

Front rectus abdominus and

March/April 2010 Vol. 23, No.2

Contents of the abdomen:

inferior vena cava

Organs of Digestion and Absorption of Nutrients The Alimentary Canal

March/April 2010 Vol. 23, No.2

The Organs of the Excretory System:

The Reproductive Organs:

March/April 2010 Vol. 23, No.2

Supporting Structures of the Peritoneum:

The Circulatory System of the Peritoneal Cavity.

Anatomy of the Peritoneum by Quadrant:

Left Upper Quadrant LUQ:

Right Upper Quadrant RUQ:

Right Lower Quadrant RLQ:

Left Lower Quadrant LLQ:

March/April 2010 Vol. 23, No.2

Small and large intestines, bladder, gallbladder, stomach, appendix, uterus.

Kidneys, liver, pancreas, spleen, ovary.

Pathophysiology of Blunt Trauma:

Pathophysiology of Penetrating Trauma:

Symptoms of Abdominal Trauma:

March/April 2010 Vol. 23, No.2

Treatment of Abdominal Trauma:

Injuries to the external genitalia:

Impact Injuries: Examine for swelling or bleeding.

March/April 2010 Vol. 23, No.2

Measuring Success in the Face of Disaster

March/April 2010 Vol. 23, No.2

By Frank Hubbell D.O.

illustrations by T.B.R. Walsh

Tales of the Tapewor m

Myiasis: Dipterous fly larva, botfly, flystrike or fly-blown. ( January/February 2010)

March/April 2010 Vol. 23, No.2

Typical sand flea measures only 1mm across

Areas where Tungiasis penetrans are endemic

Treatment of Tungas penetrans:

Annoying ailments, afflictions, and mishaps. . . .

Backpack Palsy = Rucksack Paralysis = Brachial Plexopathy:

Originating in the neck, the brachial plexus is a bundle

March/April 2010 Vol. 23, No.2

Load balancing straps

Padded waist belt

March/April 2010 Vol. 23, No.2

Symptoms of backpack palsy:

Dull ache or pain in one or both shoulders

Treatment of backpack palsy:

Prevention of backpack palsy:

Wear a properly fitting backpack

March/April 2010 Vol. 23, No.2

Properly fitting backpack: