Wilderness Medicine Updates – Détails, épisodes et analyse

In this episode, Dr. Patrick Fink reviews accidental hypothermia for wilderness providers, building on Ep. 27 Thermoregulation, explaining physiologic changes as core temperature falls  and why accurate core temperatures are difficult to obtain in the field. 

We learn the modified Swiss staging system (0–4) based on signs and symptoms and outlines field management: 

- 0 cold stress (shelter, dry/insulate, warm calories; avoid alcohol), 

- 1 mild hypothermia (ataxia/fine motor impairment; passive plus active external rewarming with a hypothermia wrap and heat near axilla/groin; frequent reassessment), 

- 2 moderate hypothermia (confusion/lethargy; active external rewarming, evaluate hypoglycemia, gentle handling and no exertion to avoid afterdrop, cardiac monitoring, expedite evacuation), 

- 3 severe hypothermia (unresponsive with vital signs; airway/ventilation support, extremely gentle transport)

- 4 hypothermic cardiac arrest (60-second pulse check, CPR, limited shocks under 30°C, withhold epinephrine/amiodarone under 30°C, consider intermittent CPR per protocol, and note potassium’s role in termination decisions). 

We also briefly contrasts slow non-extracorporeal warming with ECMO/cardiopulmonary bypass, previewing a future episode on advanced care and the HOPE score

Links

Episode 27: Thermoregulation

WMS 2019 Accidental Hypothermia Guideline

AHA Hypothermia Guidelines

European Resuscitation Council Hypothermia Algorithm

Chapters:

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

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

Reevaluating Spinal Motion Restriction: Evidence Update

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

Links

Ep. 14 - Spinal Immobilization Guidelines Update

2018 ACEP/NAEMSP Sminal Motion Restriction Position Statement

Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature

Chapters

00:00 Introduction to Wilderness Medicine Updates

00:42 Historical Perspective on Spinal Immobilization

01:44 Transition to Spinal Motion Restriction

03:30 Review of Recent Literature

05:40 Key Findings on Spinal Motion and Neurological Outcomes

09:30 Effectiveness of Backboards and Cervical Collars

12:10 Potential Harms of Immobilization Tools

16:38 Practical Recommendations and Future Directions

21:48 Conclusion and Final Thoughts

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode of Wilderness Medicine Updates, host Patrick Fink interviews Moose Mutlow, an experienced outdoor educator and search and rescue professional with nearly four decades of experience globally. Moose discusses his extensive career from being an Outward Bound instructor to working with Yosemite Search and Rescue, and his role as a Family Liaison Officer for the National Park Service. The conversation touches on the challenges faced by search and rescue teams, the importance of robust communication skills, and how to build resilience against trauma in high-stress professions. Moose also shares his personal experiences, reflecting on the value of mentorship, the significance of team dynamics, and the essential need for compassionate support during crises. The episode includes practical advice for those in the field of wilderness medicine and search and rescue, highlighting the necessity of emotional balance and continuous learning.

Connect with Moose:
Website
Blue Sky
Instagram
Substack
Book: Searching
Book: When Accidents Happen

Did you enjoy this episode? Contribute to YOSAR!

Links from the show:
The Stress Continuum
Responder Alliance
Quell Foundation
Dr. Nicola Lester: trauma informed practice

More Reading:
Ranger Confidential
Nature Noir
The Cold Vanish
The Last Season

CHAPTERS
00:00 Introduction and Guest Welcome
00:19 Moose Motlow's Background and Career
01:58 Challenges in Search and Rescue
02:58 The Importance of National Parks
05:23 Moose's Nickname and Early Career
07:07 Transition to the US and Outdoor Adventures
10:54 Search and Rescue Experiences
15:20 Swift Water Rescue Operations
19:38 Training and Mentorship in SAR
30:18 Role of Family Liaison Officer
45:24 Managing Emotional Burden as a Liaison Officer
47:12 Recognizing and Addressing Trauma
48:36 The Importance of Peer Support
49:44 Cultural Norms and Vulnerability
51:05 The Cost of Ignoring Trauma
53:37 Building Resilience and

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, we dive into one of the most overlooked but deadly hazards in deep powder skiing: snow immersion suffocation (NARSID). Unlike avalanches, snow immersion deaths happen silently—often within feet of a groomed run—when skiers and snowboarders fall into deep snow or tree wells and become trapped. We explore the research behind these incidents, where and how they occur, who is most at risk, and the tragic mechanics of asphyxiation in deep snow. Using studies from Van Tilburg, Baugher, and Cadman, we break down ra eal survival story, discuss prevention strategies, and how both bystanders and professional rescuers should respond. Whether you’re a backcountry adventurer, resort skier, or ski patroller, this episode will change the way you think about deep snow safety. Stay aware, ski with a partner, and stay out of tree wells.

Must Watch: GoPro Awards: Tree Well Rescue

Citations

Baugher, P. (2006). Risk trends at U.S. and British Columbia ski areas: An evaluation of the risk of snow immersion versus avalanche burials. In Proceedings of the 2006 International Snow Science Workshop (pp. 584–591). International Snow Science Workshop.
URL: https://arc.lib.montana.edu/snow-science/item/2076

Cadman, R. (1999). Eight nonavalanche snow-immersion deaths: A 6-year series from British Columbia ski areas. The Physician and Sportsmedicine, 27(13), 31–43.
URL: (No publicly available link found—may be available through institutional access)

Van Tilburg, C. (2010). Non–avalanche-related snow immersion deaths: Tree well and deep snow immersion asphyxiation. Wilderness & Environmental Medicine, 21(3), 257–261.
URL: https://doi.org/10.1016/j.wem.2010.04.004

Van Tilburg, C. S., Grissom, C. K., Zafren, K., McIntosh, S. E., Radwin, M. I., Paal, P., et al. (2017). Wilderness Medical Society practice guidelines for the prevention and management of avalanche and non-avalanche snow burial accidents. Wilderness & Environmental Medicine, 28(1), 23–42.
URL: https://doi.org/10.1016/j.wem.2016.10.001

Chapters
00:00 Introduction: The Hidden Dangers of Snow Immersion
00:37 Understanding Snow Immersion Suffocation
02:58 Historical Context and Research
03:09 Where and How Snow Immersion Happens
04:54 Mechanics of Snow Immersion Traps
06:23 Risk Factors and Victim Profiles
09:27 Prevention and Safety Measures
11:48 Rescue Techniques and Immediate Response
13:34 Professional Rescuer Guidelines
16:12 Advanced Medical Care and Resuscitation
20:11 Conclusion and Final Thoughts

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

King Tube vs IGEL for Airway Management

In this episode of Wilderness Medicine Updates, Dr. Patrick Fink addresses a listener's question on whether to use a King Tube or an IGEL as an out-of-hospital airway adjunct. The episode begins with an overview of airway management techniques from mouth-to-mouth resuscitation to supraglottic airway devices. Dr. Fink explains the benefits and drawbacks of various airway adjuncts, including oral and nasal pharyngeal airways. The discussion then shifts to a detailed comparative analysis of King Tubes and IGELs based on retrospective and prospective studies. Dr. Fink evaluates the evidence indicating that IGEL may be more effective and easier to use than King Tubes, particularly in pre-hospital cardiac arrest situations. The episode concludes with recommendations for pre-hospital providers and an encouragement for listeners to share their questions and feedback.

Links:

iGel LMA

King Tube

Smida T, Menegazzi J, Scheidler J, et al. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023;188:109812. doi:10.1016/j.resuscitation.2023.109812

Smida, Tanner & Menegazzi, James & Crowe, Remle & Scheidler, James & Salcido, David & Bardes, James. (2023). A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital emergency care. 28. 1-13. 10.1080/10903127.2023.2169422. 

Lønvik, M.P., Elden, O.E., Lunde, M.J. et al. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 21, 51 (2021). https://doi.org/10.1186/s12873-021-00444-0

Chapters

00:00 Introduction and Listener Question

00:55 Understanding Airway Adjuncts

02:12 Basic Airway Management Techniques

06:34 Advanced Airway Devices: King Tube and LMA

11:35 Comparative Studies on Airway Devices

17:35 Prospective Data and Final Thoughts

25:24 Conclusion and Listener Engagement

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

Exploring Methoxyfluorane for Wilderness Pain Management with Dr. Ross Hofmeyr

In this episode of Wilderness Medicine Updates, host Dr. Patrick Fink discusses the use of methoxyfluorane, an anesthetic gas for pain management in wilderness settings. Joined by guest Dr. Ross Hofmeyr, an anesthesiologist and wilderness medicine expert from South Africa, the episode delves into the history, usage, benefits, and limitations of methoxyfluorane. Highlighting its efficacy, ease of use, and safety, especially for pre-hospital scenarios, Dr. Hofmeyr shares insights into its ideal applications, contraindications, and personal experiences. The episode underscores the significance of methoxyfluorane as a potent analgesic suitable for acute traumatic pain and procedural analgesia in austere environments.

Links

Wild Medix

Ross Hofmyer on Instagram

The Inhaler Device

Methoxyflurane at Altitude - Case Report

Methoxyflurane in the Outback - Survivor Clip

WMS Pain Management Guidelines

Chapters:
00:00 Welcome to Wilderness Medicine Updates
00:55 Meet Dr. Ross Hofmeyr
03:14 Dr. Hoffmeier's Background in Wilderness Medicine
04:45 Methoxyfluorine: An Overview
12:20 The Mechanics of Methoxyfluorine Inhaler
20:15 Practical Applications in Pre-Hospital Pain Control
20:53 Analgesic Intervention: Quick and Effective
21:09 Using Methoxyfluorane in Wilderness Settings
22:42 Training Non-Medical Personnel
23:49 Procedural Analgo-Sedation
24:30 Regulatory Considerations and Prescriptions
26:33 Combining Methoxyfluorane with Other Medications
28:10 Monitoring and Safety
29:09 Ambulating Patients with Methoxyfluorane
31:31 Environmental Considerations: Temperature and Altitude
40:10 Cost and Practical Downsides
41:45 Conclusion and Final Thoughts

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

Ketamine Use in Wilderness Pain Management: An Interview with Dr. Chris Van Tilburg

In this episode of Wilderness Medicine Updates, host Patrick Fink discusses wilderness pain control with guest Dr. Chris Van Tilburg, focusing on the effective use of ketamine. The episode delves into how ketamine serves as a versatile medication for pain management, sedation, and intubation in emergency and wilderness environments.

Dr. Van Tilburg, an expert in wilderness medicine with extensive field experience, shares insights on administering ketamine in challenging rescue scenarios, the limitations and benefits of various medications, and practical considerations for field use. The conversation touches on dose ranges, administration techniques, and patient management during rescues. Additionally, Dr. Van Tilburg talks about his soon-to-be-released book, 'Crisis on Mount Hood: Stories from 100 Years of Mountain Rescue,' celebrating the centennial of the Crag Rats, America's oldest mountain rescue team.

Links
WMS Guideline: Avalanche and Nonavalanche Snow Burial

WMS Guideline: Pain Management in Austere Environments 

Chris’s Linktree

Contact Chris through LinkedIn

Preorder Chris’s book “Crisis on Mt Hood”

Chris on Wikipedia

Crag Rats Mountain Rescue

Chapters:
00:00 Welcome and New Year Greetings
00:29 Introducing Today's Guest: Dr. Chris Van Tilburg
03:07 Podcast Shoutouts and Listener Appreciation
03:37 In Conversation with Dr. Chris Van Tilburg
05:58 Challenges of Wilderness Pain Management
09:37 Pain Management Strategies
14:23 Ketamine vs. Other Pain Medications
18:01 Ketamine Dosage and Administration
22:16 Nitty Gritty Tactics: Needle Sizes and Administration
23:02 Intramuscular Injection Sites and Techniques
24:22 Timing and Dosage of Ketamine Administration
25:16 Challenges in Mountain Rescue Situations
27:17 Case Study: Seizure Patient and Ketamine Use
29:18 Considerations for Head Injuries and Ketamine
33:03 Medications in Wilderness Medical Kits
34:02 The Art of Wilderness Medicine
37:54 Protecting Medications in the Field
38:55 Wrapping Up: Upcoming Book and Final Thoughts

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In episode 17 of Wilderness Medicine Updates, host Patrick Fink delves into the ICAR resuscitation algorithm for buried avalanche victims. The episode reviews the physiology of avalanche burial and discusses critical determinants of survival, such as duration of burial, airway patency, signs of life, and lethal injuries. The Basic Life Support (BLS) and Advanced Life Support (ALS) algorithms are explained in detail, with a focus on the practical application for both amateur and professional rescuers.

The episode also includes two detailed case studies that illustrate the application of the resuscitation algorithm, providing listeners with practical scenarios to better understand the protocols. Key insights on the importance of quick action, hypothermia, and ongoing CPR are highlighted, making this episode essential listening for anyone involved in avalanche rescue operations.

Ep. 12 - Resuscitation of the Buried Avalanche Victim, Part 1: Physiology

ICAR Rescue Algorithm

ICAR Paper in Resuscitation

Chapters:
00:00 Ep. 17 - Resuscitation of the Buried Avalanche Victim, Part 2
01:26 Review
08:52 BLS Algorithm
14:30 ALS Algorithm
25:30 Interlude
25:30 Case 1: Partner Rescue
31:01 Case 2: Professional Rescue
39:54 Conclusion/Outro

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, I share an intense story of dealing with a suprise medical condition during a backcountry hut trip in Colorado. I walk through the diagnostic process, treatment options, and the importance of preparation for stays in remote places. Essential medications and tools needed for handling such emergencies in remote settings are discussed, along with advice on how to prepare for future expeditions.

My articles on The-High-Route.com

The Hut Medication Card

Chapters: 

00:00 Introduction and Personal Update

01:31 The Backcountry Hut Trip Begins

03:19 Will's Health Deteriorates

04:38 Diagnosing the Problem

07:04 The Emergency Descent

09:16 Lessons Learned and Preparedness

10:37 Essential Medications for Wilderness Trips

16:19 Final Thoughts and Conclusion

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.

This episode, I look at a study from the Eurac research group on rates of airway occlusion in critically buried avalanche victims. Eurac looked at this critical feature of avalanche resuscitation triage as it both affects the way we treat buried avalanche victims, and it helps us to better understand whether technologies like the black diamond Avalung (retired) and the Safeback SBX can help us survive longer under the snow if buried.

Full study text HERE

The High Route article on the Safeback system HERE

Episode 12: Avalanche victim physiology. Listen on web, Apple Podcasts, or Spotify.

Episode 14: Spinal immobilization updates. Listen on web, Apple Podcasts, or Spotify.

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

Connect with us by email at wildernessmedicineupdates@gmail.com.

You can pay us a compliment and share the show with a new listener on any popular platform here.