Basic Wilderness Med. Concepts

Here is a summary of a 1.5 hr session I did for the Royal College Residents in Victoria, BC.

We covered a broad range of topics: what is wilderness medicine, the wilderness-assessment-pyramid (WmAP); hypothermia; trip planning; basic medical emergencies; first aid kits. 

You can find the PDF slides here: primer-on-wilderness-medicine-for-rc-residents-1.

The wilderness medicine assessment triangle (WmAT):

wilderness-asessement-pyramid-v-1-chris-lipp-large

Basic medical emergencies: 

  • Here’s the link on how to disassemble an Epi-pen and use the remaining 3-4 doses
  • Managing chest pain in the wilderness (see the slides)
  • Shoulder dislocation reduction
    • I really like the Cunningham technique. This is a YouTube video on it.

Here is an excellent resource from the International Commission for Alpine Rescue. It’s a 132 page pdf with consensus guidelines on mountain emergency medicine and risk reduction.

First aid kit list:

The best first aid kit, is the one you have with you.

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Chickpea Cardamom Pear Protein Muffins

For those of you tired of the standard muffin – enter these beauties. Close your eyes and take a journey to Annapurna.

They are packed with protein, fibre and a little Indian spice. If the fact that they contain the mystical healing spice cardamom (with some science (1, 2) to back up all the hype) wasn’t enough, they are gluten free, dairy free, flour free and have all the benefits of chickpeas and pears.

Here’s how to make them*:

Ingredients for ~12 medium muffins:

  • 1 can chickpeas (519 ml/19 oz size)
  • 4 eggs
  • 1 grated medium-sized pear
  • 1/4 cup coconut sugar
  • 2 tsp cinnamon
  • 1 tsp baking powder
  • 1/2 tsp cardamom
  • pinch of salt

Topping:

  • Any berries (fresh or frozen) – I used raspberries
  • Any nut (e.g. sliced almonds, cashews, etc).

Steps:

  1. Drain and rinse the chickpeas
  2. Blend the chickpeas and eggs in a food processor/blender to a smooth batter
  3. Add the grated pear, spices, sugar, and salt in a food mixing bowl (or by hand)
  4. Add the blended chickpea/egg paste to the mixing bowl and mix it all!
  5. Place batter in a lined muffin tin
  6. Drop a few berries and nuts on top
  7. Bake at 350 F for 30 mins (until toothpick comes out clean)
  8. Let stand on counter for 5 mins, then carefully remove muffins from the tin so they can cool off and not become soggy on the bottom
  9. Sit down and and enjoy them with friends!

 

img_20170115_095704

*recipe adapted from: Pretty Sweet

 

Sports medicine rehab exercises and app compilation

Wanna get your knee/shoulder/ankle working again so you can start rehab-ing in 2017?

Here are some of my favorite resources for bone/joint/muscle rehab. These are some of my go-to resources at work and for friends!

I decided to centralize all my favorite links to resources on a broad range of sports medicine topics here

There are a bunch to choose from and I’ve broken them into body part (scroll down) as well as my favorite all-in-one free phone/tablet app that gives you exercises for every major body part.

The Get Set app is a must have!

It’s called “Get Set“. It’s available for Apple products from iTunes as well as Android

Get Set is a great, free phone application that helps any athlete – recreational or professional – cross train and rehab their body based on specific anatomic areas or by sport.

Here is my “ultimate” compilation list; please comment below if you have additions or if any of the links are broken! If you know of something better please let me know! *= a favorite

 

 

 

 

 

For runners:

For some other instructional videos on YouTube “DrJo” has a decent selection of videos

Here are a bunch of brochures from the American College of Sports Medicine and here are a list of topics (ankle sprain, PFPS, nutrition basics,  heata illness, achilles tendinopathy) from the AMSSM in two page print-able handouts.

Missing something? Try using UpToDate’s patient information search engine to access free informational resources.

Here is a one amazing page of great handouts from Vanderbilt University. They include all topics.

Information specific to Victoria, BC: through Rebalance MD:

***It’s extremely important to get personalized coaching by an athletic therapist or physiotherapist to make sure you’re doing these exercises correctly!***

For more detailed information about the Get Set app:

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Compression Socks – review

Stand a lot? Ever wondered if prolonged standing is harmful or how you can get through those long days where you’re always on your feet?

I’m (Chris) on my feet a lot for work.  Last January, on my ICU rotation, I really started to notice how sore my legs were after those 24 hour shifts.  For the past 10 months I’ve been wearing compression socks and have been impressed with the results!

I noticed less leg/calf aching during my ICU and ER shifts so much so that now I wear compression socks even when my workplace is a clinic or an office.  I feel they help me concentrate better at work – because I’m less stressed about my achy calves (maybe I’m a wuss!).

If your workplace is static – you are in one position for long periods of time – you need to modify what you wear or how you work!

Recently I also tried them out when I traveled to Uganda. They performed well despite the arduous 30+hrs of travel time, keeping my feet climate controlled (yes! read below why wool worked!) and ache free from all the venous pooling.

These benefits are also especially important for those of us athletes who regularly stress our bodies with sports / long distance running / cycling / etc.! We all want to healthy legs so we can climb the next mountain!

Here are the various pairs of socks I’ve worn listed in order of preference. The top three could basically be tied…they will not disappoint depending on what you’re looking for! The last two aren’t worth buying.

  1. Icebreaker Men’s Hike+ Compression
  2. Abco Tech – compression socks
  3. Smartwool Men’s PhD Run Graduated Compression Socks
  4. New Balance Compression Socks
  5. Terramed Organic Compression Socks

I’ll give you quick run down on the pros and cons of each:

Icebreaker Men’s Hike+Compressionicebreaker-socks

Pros: They are merino wool – naturally sourced, super comfy, breathable, and don’t stink. They were my go-to for my 30hr transatlantic flight. They were perfectly climate-controlled and never bothered me once. They dry very fast and can be worn multiple days without smelling.

Cons: They are pricer and don’t have the same maximal compression as some of the other socks.

Abco Tech compression socks – performance

abco-techPros: These are some of the most affordable and best compression socks I’ve had. I love how they have a super roomy toe box, are easy to put on, provide the BEST comfortable compression out of all the socks I have. They are a great choice for shift workers.

Cons: They do start smelling (they are polyester based) after one day of wearing. They feel best if you wash them in-between wearings. Some people might not like their funky colours.

 

Smartwool Men’s PhD Run Graduated Compression Socks

Pros: These are solid socks. They provide the best compression I’ve seen from a merino sock. They are also nice and ultralight.I’m very happy with their performance and comfort.

Cons: They aren’t warm enough for winter wear. They are pricer than non-wool socks.

New Balance Compression Wellnessnew-balance-socks

Pros: Inexpensive, great compression in the calf.

Cons: Difficult to get on, no toe space (squishes them!). No cushion. All polyester. Not worth it.

Terramed Organic Compression socks

Pros: Organic (?), middle of the road as far as cost goes.

Cons: Not that comfortable, mediocre compression, cotton material. Not worth it.

What does research say on the subject for standing workers or athletes? Scroll down for more information, but in summary:

“Most of the studies reviewed support the use of compression stockings in the reduction of subjective complaints of leg fatigue, pain, and swelling in work requiring prolonged standing.” – Waters & Dick, Rehabil Nurs 2015. PMCID: PMC4591921

“These data provide new information that the use of compression garments promotes a more rapid recovery of muscle function, muscle soreness and systemic CK activity when compared with a control group.” – Hill et al. BJSM 2014

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Vegetarian Leek Lentil Stew

We aren’t officially vegetarian, but I (Rachel) am moving more and more that way.  While I may not be ready to officially boycott ethically-raised, free-range, local organic chicken, it’s expensive and definitely not an every day item.

Enter: lentils.

Before you laugh, check out the nutritional profile of lentils here.  Lentils are one of my new favourite foods to cook with.  Filled with protein, fibre, potassium, folate, iron, and manganese, they are a fantastic stable to have in your kitchen (especially you iron-deficient ladies out there… and breastfeeding mamas).

I made this stew yesterday in the slow cooker and by 5pm the house smelled heavenly.  Go. Make. This. Now.

Leek Lentil Stew (Rachel’s adapted version) 

2 c red or green lentilsimg_1913

4 c vegetable broth

2 cans coconut milk

2 leeks, thinly sliced

1 red or yellow onion, sliced

1 sweet potato, cubed

1/2 large head black kale, shredded

2 tsp turmeric

2 cloves garlic

several sprigs of fresh thyme

salt and pepper to taste

So easy.  Put everything in your slow cooker and leave on low for 7-8 hours or high for 4-5 hours.  This makes a LOT so I just put some in my freezer, but you could take it for lunch the next day (sooo much better than your colleague’s PB&J).  Whip up some 15 minute dinner rolls and a fresh garden salad and your friends and family will be drooling.

YOUR’E WELCOME 🙂

Rach

PS. I concur. this recipe rocks! Chris

Mens running shorts

This short post covers my (Chris) two favorite running shorts: the Prana flex short ($59) and Patagonia nine trails ($~45-70). They’re not just for running; I recommend them for hiking, cycling, walking, or literally any high output activity where you work up a sweat and don’t want to chafe.

If you are still rocking those high-school mesh shorts you need to upgrade!

 

Prana – Flex short

prana-flex-short

These are some of the best shorts I’ve ever owned. Rachel bought them for me in 2013 and they still look brand new. I’ve done a 24 km Spartan Beast in them, hiked 75 km of the West Coast Trail, and used them 2-3x a week for 5-15 km runs for the last three years.

They have a great moisture wicking liner which provides good compression and climate control. They do start feeling a bit uncomfortable after the 15 km mark on a high-output run due to a poorly placed seam in the groin.

The outers are a light, fast drying polyester. They have one small pocket on the right thigh. It can hold an energy gel and a key or two. It closes with Velcro. I found it best to run with nothing in that pocket, which is inconvenient if you like carrying stuff with you on your runs. So if you’re looking for a long distance short check out the Nine Trails.

 

Patagonia – Nine Trails

nine-trails

Lately I’ve (Chris) been getting into longer distance runs, and I’ve found the Nine Trails shorts to work perfectly. They have slightly more compression and most importantly they have three zipper pockets. These pockets hold gels, snacks, keys, and even my phone.

The amazing features of the pockets is that the contents in them don’t bounce around.

The inner liner is seamless wicks moisture well and only starts smelling after my third-fourth run in them. It provides good support for my man parts. The outer is a light-durable fast drying material.

I’m hoping to use these shorts as I keep training for longer trail runs (possibly an ultra). 

Life-saving Epipen Hack

You just used your Epipen in the backcountry and now the medication is wearing off. Your breathing feels tight and you feel lightheaded. What to do?

This post will show you how to utilize the remaining three doses of epinephrine from an Epipen.**

You should know how to help someone having an anaphylactic reaction use their own Epipen to dispense life preserving epinephrine; “Lift blue to sky, hold and push orange to thigh.”

However, often one single dose of epinephrine from an Epipen will not be sufficient to stave off life threatening distributive shock. This is particularly an issue in remote or wilderness situations.

Why should you care? Any place where paramedics are unable to help you immediately could be a situation where a person could suffer progressive shock and suffocation which can only be helped with additional doses of epinephrine.

Yes, that could be in a downtown apartment tower, in a city park, in a ski-hill chairlift, on a rural road, on your next hike, or your next trip overseas on an intercontinental flight!

In the emergency room patients often need multiple doses of epinephrine because of ongoing low blood pressure or breathing problems. The only way to keep them alive is by giving epinephrine every 5-10 minutes.

Apparently an Epipen costs $300-$450 in the USA, this is all the more reason to know this life hack.

So, here we go!

Every Epipen has MORE than 1 dose of epinephrine in it. However for safety reasons the remaining epinephrine remains locked inside the plastic case.

Here’s two different ways to access it:

  1. Saw it open using trauma shears to open it (fastest)
  2. Cut it open (safest & slowest)

Option 1:

The simplest way is to grab a pair of trauma shears and squeeze the blade on the back 3 cm of the Epipen and cut it off. 

Now apply firm pressure on the scissors while twisting the Epipen. Soon you’ll cut through the outer plastic and the back part will pop off. See the pictures and description below for the next steps. 

Option 2: 

Use a knife as illustrated in the photos below to take it apart.

Remove the metal spring and turn the chamber upside down. A glass syringe should fall into your hand. Carefully pull off the silicone needle protector.

The syringe usually has three more doses in it. To accurately dose them draw air into the inverted syringe, then invert it again when you administer epinephrine. 

 

This demonstration was with the ADULT (yellow) Epipen. It works the same with the pediatric Epipen.

Side note: how long does my Epipen last?

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