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Psychogenic Nonepileptic Attack: (Dissociative Convulsions)

Presentation The patient with psychogenic nonepileptic attack (PNEA), also known as psychogenic nonepileptic seizure (PNES), typically presents with the appearance of having tonic-clonic seizure activity or can develop this during a visit. There may be a history of sexual abuse, eating disorders, depression, substance abuse, anxiety disorders, or personality disorders, and the episode may be preceded by a stressful event. The terminology “pseudoseizure” or “hysterical seizure”…

Hyperventilation

Presentation The patient presenting with hyperventilation syndrome typically appears anxious and exhibits shortness of breath with an inability to fill the lungs adequately. The patient also may have palpitations, dizziness, intense anxiety, fear, chest or abdominal pain, tingling or numbness around the mouth and fingers, and possibly even flexor spasm of the hands and feet (carpopedal spasm) ( Fig. 3.1 ). The patient’s respiratory volume is…

Heat Illness : (Heat Syncope, Heat Cramps, Heat Exhaustion)

Presentation Heat illnesses comprise a spectrum of illnesses resulting from failure of the body’s normal thermoregulatory mechanisms after exposure to excessive heat. Most heat-related illness is mild; however, severe hyperthermia associated with heat stroke, neuroleptic malignant syndrome, or serotonin syndrome is a severe, life-threatening condition and should not be overlooked. The milder forms of heat-related illness include heat syncope (or presyncope), or heat cramps. These illnesses…

Acute Dystonic Drug Reaction

Presentation The patient with a dystonic reaction to a neuroleptic or other agent typically presents to the emergency department (ED) or urgent care center with posturing, facial grimacing and involuntary muscle movements, and/or difficulty speaking. Pain is minimal, if at all. The jaw, tongue, lip, throat, and neck muscles are frequently involved. Hyperextension and lateral deviation of the neck along with upward gaze is a classic…

Commonly used applications of the SAM splint

This information is adapted with permission from the SAM Splint User Guide. SAM Splints (Sam Medical Products) are available in the following sizes: Standard—4 ¼ inches × 36 inches; 4 oz; roll or flatfold Junior—4 ¼ inches × 18 inches; 2.4 oz; flatfold Wrist—4 ¼ inches × 9 inches; 1.1 oz; flat XL—5 ½ inches × 36 inches; 5.9 oz; flatfold Finger—1.8 inches × 3 ¾ inches; 0.2 oz; flat General…

Conversion tables

Fahrenheit and centigrade (celsius) temperature conversion To convert degrees Fahrenheit (°F) into degrees centigrade (°C, or Celsius), subtract 32, then multiply by 5, then divide by 9. To convert degrees C into degrees F, multiply by 9, then divide by 5, then add 32. For extrapolation into “subzero” (below 0°F) range, be aware that 1 Fahrenheit degree represents the temperature change of 5⁄9 of a centigrade…

Commonly used drugs (medications) and doses

This Appendix lists drugs that are mentioned in the book, and some that are not mentioned but that might become available. No medication is without potential adverse side effect. All medication should be given with caution. Carrying a pharmacy for yourself and other trip members comes with great responsibility and should be done under the direction of a physician. Always have a doctor and/or pharmacist explain…

Procedures

Intramuscular injection Intramuscular (into the muscle) injection of epinephrine is used to manage a severe allergic reaction. The injection may be performed with a preloaded syringe (already containing the medicine in the barrel—see page 482) or might require that the medicine be drawn up for administration. After you wash your hands, follow these instructions: 1. Select the proper syringe and needle. For the treatment of an…

Transport of the injured victim

The decision to transport (i.e., evacuate) a victim is critical. Moving a patient can be incredibly complicated, arduous, and can increase the risks for a bad outcome for both the victim and rescuers. First and foremost is to consider the ability and rescue experience of the group. This is not medicine—it is logistics, including having the right people and equipment, knowing the terrain and how to…

First aid kits

First aid kits should be designed according to the environment to be encountered, number of travelers, medical training of the party leaders, and distance from advanced medical care. The following lists include items that could be included to deal effectively with the most common problems. They are not camping lists (shelter, food, toiletries, and the like). Basic survival supplies must be adequate. The more multipurpose your…

Personal safety in an age of conflict, kidnapping, and terrorism

We live in an age of conflict and travel subjects one to criminal behavior, including acts of piracy, kidnapping, terrorism and war. It is wise to be cautious, safe, and prepared to react to situations in which you might become a victim. As with any other adverse event, prevention and avoidance is key. Safe travel General crime avoidance Don’t flaunt expensive items, such as jewelry, (dive)…

Jet lag

Wilderness medicine and outdoor persons are commonly world travelers. Jet lag is a sleep disorder that results from crossing time zones too rapidly for the human biologic circadian “clock,” which is synchronized to the sun’s cycle of light and darkness, to keep pace. It has been estimated that the circadian clock resets an average of approximately 90 minutes later each day after a westward flight and…