Wilderness Medicine Updates

Dr. Patrick Fink interviews Dr. Nick Daniel and Dr. Gavin Clark about an in-hospital case of exertional heat stroke in a mid-20s runner who collapsed just before the finish of an October New England half marathon in 45°F weather. EMS treated presumed SVT with adenosine, but in the ED the patient was hypotensive, profoundly diaphoretic, and altered; an oral temperature was normal while a rectal core temperature was 105.5°F, highlighting that peripheral temps can’t rule out heat stroke. We discuss rapid “cool first” management using ice packs, misting, and fans to reach 102°F within ~30 minutes, compare cooling methods (cold-water immersion, tarp-assisted oscillation, Quantico method, frozen sheets), review labs showing lactate 9 and AKI, explain sepsis-like physiology via gut hypoperfusion, and note possible risk contribution from recent COVID and acute Lyme IgM positivity. Links:Ep. 33 - Heat Illness FundamentalsEp. 27 - Thermoregulation: The Physics and Physiology of Body Temperature RegulationClark G, Kocen S, Daniel N. Icy Hot: A Case of Unexpected Heat Illness. Wilderness Environ Med. 2026 Jun 16:10806032261458332. doi: 10.1177/10806032261458332. Epub ahead of print. PMID: 42300334.Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness & Environmental Medicine. 2024;35(1_suppl):112S-127S. doi:10.1177/10806032241227924Chapters:00:00 Show Intro and Guests02:43 Meet the Doctors03:48 Race Day Collapse Setup04:47 Finish Line Differential06:48 EMS Report and History08:55 Core Temp Surprise11:25 Field Temp Takeaways13:38 Rapid Cooling in ED15:36 Cooling Rates and Goals16:28 Immersion and Alternatives18:17 Tarp and Body Bag Hacks19:32 Quantico and Frozen Sheets21:10 Field Cooling Methods21:48 Lab Workup Red Flags23:23 Lactate Nine Explained24:21 Heatstroke Sepsis Pathway26:40 Hidden Factors COVID Ticks29:09 Fever Versus Hyperthermia31:27 Prehospital Takeaways35:00 Race Day Kit Checklist36:35 Cool First Transport Later37:29 Outcome And Wrap Up39:46 Podcast Closing NotesAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.

Forty to seventy-five percent of tourniquets placed in the field are never actually needed. In Ukraine, tourniquets left on too long during delayed evacuations have cost people limbs that the original wound never would have.This fast push covers the new May 2026 TCCC Guidelines update and two CoTCCC training briefs on tourniquets, built around lessons from prolonged evacuations in the Russo-Ukrainian war. Topics: telling truly life-threatening bleeding from bleeding that just looks bad, the case of an 11.5-hour tourniquet that cost an arm, reassessment moving from a medic-only skill to something every responder needs, the six options at reassessment (remove, convert, reposition, tighten, add a second, leave alone), how to convert a tourniquet, and what changes once one's been on past six hours.Takeaway: applying a tourniquet is the easy part. Knowing what to do with it for the next several hours is what actually saves the limb.References:Committee on Tactical Combat Casualty Care. TCCC Guidelines, 01 May 2026. https://deployedmedicine.com/tccc Full guidelines PDF: https://learning-media.allogy.com/api/v1/pdf/18ccfdfc-a076-47e9-8a34-376efdd81b43/contentsButler F, Holcomb J, Dorlac W. TCCC Quick-Look: What Kind of Bleeding Requires a Tourniquet? 19 May 2026. https://www.aast.org/static/dadfd895-d295-4a5d-9f45f8d92940991c/TCCC-260521-TCCC-Quick-Look-Who-Needs-a-Tourniquet.pdfKoch EJ, Andersen M, Barbee GA, et al. Standardizing Tourniquet Reassessment and Conversion Across TCCC Tiers: TCCC Guidelines Proposed Change 25-2. J Spec Oper Med. 2026;26(1):M4V1-O3Y7. This is the peer-reviewed paper behind the Tourniquet Reassessment Quick-Look. https://jsomonline.org/product/standardizing-tourniquet-reassessment-and-conversion-across-tccc-tiers-tccc-guidelines-proposed-change-25-2/ PubMed: https://pubmed.ncbi.nlm.nih.gov/41818038/As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.

Dr. Patrick Fink reviews the spectrum of heat illness using 2024 Wilderness Medical Society guidelines, covering recognition, physiology, field treatment, and key mimics. He distinguishes heat edema, heat cramps (salt-depletion vs exercise-associated), heat syncope and exercise-associated collapse, and defines heat exhaustion by preserved mental status versus heat stroke by altered mental status in a heat context, warning not to wait for a temperature threshold. He explains heat stroke pathophysiology as direct thermal injury plus a sepsis-like inflammatory cascade from gut hypoperfusion and barrier failure, emphasizing “heat × time” and a 30-minute cooling window. Core management is “cool first, transport second,” with cold water immersion as gold standard and improvised “tarp taco” alternatives; stop cooling around 38.3–38.8°C, avoid antipyretics and dantrolene, and use fluids only as support. He highlights exercise-associated hyponatremia as a dangerous mimic requiring hypertonic saline, and discusses disposition, including possible field release after full recovery within two hours for healthy exertional cases.LinksEpisode 27: Thermoregulation: The Physics and Physiology of Body Temperature RegulationWilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 UpdateChapters00:00 Heatstroke Trail Scenario01:02 Episode Roadmap03:34 Thermoregulation Basics06:43 Mild Heat Illness11:21 Heat Exhaustion Line13:32 Heat Stroke Recognition17:18 Why Heatstroke Kills22:37 Cool First Transport Second24:51 Cold Water Immersion27:31 Improvised Field Cooling28:28 Myths Meds and Fluids33:56 Hyponatremia Mimic36:57 Disposition and Transport39:38 Gear and Preparation41:05 Key Takeaways Wrap UpAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.

That EpiPen in your kit expired eighteen months ago. Anaphylaxis is happening. Do you use it?This episode digs into a 2025 systematic review from the American Red Cross Scientific Advisory Council that asked a question most of us have quietly wondered about: do expired resuscitation medications still work? We walk through the evidence on the four drugs that matter most in the field — albuterol, aspirin, epinephrine, and naloxone — and what the science actually says when in-date meds aren't an option.In this episode:Why the expiration date is a manufacturer's guarantee, not a tombstone — and what it actually measuresThe honest limitation behind all 17 studies: this is bench chemistry, not human outcomesAlbuterol holding 98% potency 20–30 years out, and why the inhaler's valve is the real weak linkThe aspirin asterisk: solid for years, but down to under 12% active drug at 28–40 yearsEpinephrine that's gone a little brown — discolored doesn't mean toxic, it means weakerThe nornaloxone question, and why decades-old naloxone still isn't dangerousSterility, storage, and the dashboard-baked-pen problem the studies couldn't answerWhere the ethics land: doing something with a probably-weakened drug vs. doing nothingThe takeaway: Carry in-date meds. Rotate your stock. Store them cool and dark. But throw out the binary — in a real emergency with no alternative, that expired pen very likely still has most of its fight left.The mountain doesn't check expiration dates. Neither does anaphylaxis.Reference: Charlton N, Berry DC, Kannan V, Yee R, Carlson JN, Orkin AM. "The use of expired resuscitation medications for life-threatening first aid conditions: a systematic search and narrative review." Resuscitation Plus. 2025;26:101110. Open access (CC BY).As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.

Prehospital Airway Fundamentals for BLS: Positioning, Pocket Mask, NPA/OPA, BVM, and LMADr. Patrick Fink presents a BLS-focused airway fundamentals episode for prehospital and wilderness/SAR responders, emphasizing an ingrained, stepwise approach to stave off respiratory badness. Links:Airway Fundamentals VideoIntersurgical iGel LMAChapters:00:00 Airway Basics Overview01:52 Questions And Upcoming Episodes04:04 Scenario Mountain Biker05:33 Airway Positioning Jaw Thrust09:42 Pocket Mask Ventilations13:24 Nasal Airway NPA17:53 Oral Airway OPA22:22 Putting It All Together24:26 Oxygen And Bag Valve Mask29:03 PEEP Valve Tips30:29 Laryngeal Mask Airway35:52 Full Airway Algorithm Walkthrough38:39 What I Carry In My Kit39:39 Practice And Mental Rehearsal42:17 Wrap Up And Support The ShowAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.

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 scoreLinksEpisode 27: ThermoregulationWMS 2019 Accidental Hypothermia GuidelineAHA Hypothermia GuidelinesEuropean Resuscitation Council Hypothermia AlgorithmChapters:00:00 Welcome and Overview00:48 Hypothermia Basics01:12 Cooling Physiology04:06 Severe Effects and Arrhythmias06:38 Field Temp Challenges07:41 Swiss Staging Intro08:35 Stage 0 Cold Stress11:40 Stage 1 Mild Hypothermia16:04 Stage 2 Moderate Hypothermia20:44 Afterdrop and Handling22:54 Stage 3 Severe Hypothermia27:00 Stage 4 Cardiac Arrest27:57 CPR Shocks and Drugs37:01 Advanced Rewarming ECMO43:26 Key Takeaways Summary46:57 Wrap Up and SupportAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.

Reevaluating Spinal Motion Restriction: Evidence UpdateIn 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.LinksEp. 14 - Spinal Immobilization Guidelines Update2018 ACEP/NAEMSP Sminal Motion Restriction Position StatementPrehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the LiteratureChapters00:00 Introduction to Wilderness Medicine Updates00:42 Historical Perspective on Spinal Immobilization01:44 Transition to Spinal Motion Restriction03:30 Review of Recent Literature05:40 Key Findings on Spinal Motion and Neurological Outcomes09:30 Effectiveness of Backboards and Cervical Collars12:10 Potential Harms of Immobilization Tools16:38 Practical Recommendations and Future Directions21:48 Conclusion and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.

Wilderness Orthopedics: Managing Trauma in Remote Environments with Dr. Chris HealyIn this episode of Wilderness Medicine Updates, host Dr. Patrick Fink tackles orthopedic injuries in the wilderness with Dr. Chris Healy, an orthopedic surgeon and outdoor enthusiast. They explore the management of long bone fractures, traction for femur, pelvic binders, and the nuances of treating injuries in limited-resource environments. The episode covers strategies for handling common injuries like shoulder dislocations, tibia fractures, knee injuries, and how to prioritize care. They also emphasize the importance of timely evacuation and when and how to safely attempt reductions in the field.Links:Donate to the Tina Biddle Memorial ScholarshipSulcus sign / Squaring of the shoulderChapters:00:00 Introduction and Episode Overview01:36 Tribute to Tina Biddle04:09 Meet Dr. Chris Healy05:11 Ski Patrol Background and Pre-Hospital Care08:12 Approaching Orthopedic Injuries in the Field17:50 Managing Tibia and Fibula Fractures21:40 Understanding Compartment Syndrome27:50 Femur Fractures and Traction Splinting36:57 Pelvic Fractures: Identification and Management38:41 Understanding Pelvic Fractures and Binders39:53 The Role of Pelvic Binders in Pre-Hospital Care41:11 Challenges with Pelvic Binders in the Field43:15 Proper Placement of Pelvic Binders46:36 Field Management of Shoulder Dislocations50:43 Techniques for Reducing Shoulder Dislocations54:17 Managing Upper Extremity Injuries57:51 Handling Knee Injuries in the Field01:00:37 Patella vs. Knee Dislocations01:08:06 Evacuation Priorities for Knee Dislocations01:10:53 Common Issues in Pre-Hospital Orthopedic Care01:15:36 Final Thoughts and Listener EngagementAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.

Understanding Stress Injuries in First Line Responders with Laura McGladreyThis episode of Wilderness Medicine Updates, hosted by Patrick Fink, features a conversation with Laura McGladrey, founder of the Responder Alliance. They discuss the critical issue of stress injuries among first line responders, including professional ski patrollers, healthcare workers, and rescue team members. Through personal stories and expert insights, Laura explains the concept of stress injuries, how they develop, and the importance of early detection and mitigation. The episode highlights the need for both individual and organizational strategies to support resilience and manage stress. Listeners are introduced to practical tools, cultural shifts, and personal anecdotes to help maintain a long, healthy, and fulfilling career in high-stress environments.LinksResponder Alliance Home PageAccess all that the organization has to offer.Responder Alliance: Resource HubEasy access to critical tools and offerings.The Stress ContinuumSee the visual continuum that we discuss on the show.Scholarships: Responder Alliance FoundationApply for aid for an individual or team training.Make a Donation to Responder Alliance Foundation!Join me in making a tax-deductible donation to support the valuable work of the Responder Alliance and bring this work to those who need it, regardless of cost.Chapters00:00 Introduction and Guest Welcome02:11 Laura's Background and Work06:00 Understanding Stress Injuries10:02 Responder Alliance Mission and Challenges20:55 Critical Incident Stress Management30:49 Empowering First Responders32:13 Daily Investments in Resilience37:26 Recognizing and Managing Stress38:14 Organizational Support for Stress Management39:45 Building Resilient Teams46:12 Learning from Resilient Leaders52:42 Resources for Stress Mitigation57:54 Conclusion and Final ThoughtsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] 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 delves into the topic of thermoregulation, explaining how our bodies regulate temperature in response to environmental changes. Listeners will learn about methods of heat exchange (conduction, convection, radiation, and evaporation), how to measure core temperature, and the body's physiological responses—such as shivering, sweating, and blood flow control. The episode also touches on the effects of age, metabolic stressors, and pregnancy on thermoregulation, as well as the importance of understanding these principles in the context of treating conditions like hypothermia and heat-related illnesses.00:00 Introduction and Episode Overview01:29 Importance of Thermoregulation03:12 Human Thermoregulation Mechanisms04:20 Measuring Core Temperature07:55 Heat Exchange Methods14:52 Behavioral and Physiological Responses24:48 Sex and Age Differences in Thermoregulation27:14 Conclusion and Next StepsAs always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at [email protected] can pay us a compliment and share the show with a new listener on any popular platform here.