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Aeromedical Transport

Because aeromedical transport involves medical care delivered in a hostile environment, the patient and crew are at risk for injury or death in the event of a mishap. Flight crew training must emphasize safety. A helicopter mountain rescue operation is a high-risk endeavor for the pilot and crew, as well as for the patient. Dangerous mistakes are easy to make around working helicopters. Therefore, aeromedical transport…

Improvised Litters and Carries

Scene Size-Up To select the best method for bringing a patient to definitive care, the rescuer must make a realistic assessment of several factors: Scene safety is the initial priority. The necessary evaluation, called the scene size-up ( Box 57.1 ), involves a (usually hasty) determination of whether the patient, rescuer, or both are immediately threatened by the environment or situation. Box 57.1 Scene Size-Up Factors…

Search and Rescue

This chapter addresses broad concepts of wilderness search and rescue (SAR); responders should evaluate their circumstances and seek specific training for the types of incidents they may encounter. Not all rescuers need to be trained to the most advanced levels of wilderness operations, and individuals should always operate within the limits of their experience and training. Before attempting to respond to any rescue incident, responsible persons…

Aquatic Skin Disorders

Among the disorders acquired in water that affect the skin are various dermatoses, cutaneous larva migrans, infections, sensitivity to diving equipment, pseudomonal folliculitis, and otitis externa. Disorders Sargassum Algal Dermatitis Signs and Symptoms Skin erythema, urticarial papular pruritus Treatment 1. Promptly wash with soap and water to remove toxins. 2. Treat a mild to moderate reaction with antihistamines and a topical medium-potency corticosteroid preparation ( Table…

Seafood Toxidromes

Toxidromes associated with seafood that may be encountered in the wilderness are ciguatera fish poisoning, clupeotoxin fish poisoning, scombroid fish poisoning, tetrodotoxin fish poisoning, paralytic shellfish poisoning (PSP), diarrhetic shellfish poisoning, Vibrio fish poisoning, anisakiasis, domoic acid intoxication, gempylotoxism, botulism, and Pfiesteria syndrome. Ciguatera Fish Poisoning Ciguatera fish toxins are carried by more than 400 species of bottom-feeding reef fishes. The most frequently affected fish are…

Envenomation by Marine Life

Interactions with various forms of marine life can result in stings and puncture wounds that lead to envenomation or anaphylactic reactions. Anaphylaxis For signs, symptoms, and treatment of anaphylactic reactions, see Chapter 26 . Reaction to Sponges Sponges (see Plate 36 ) are stationary animals that attach to the sea floor or coral beds. Embedded in their connective tissue matrices are spicules of silicon dioxide or…

Injuries From Nonvenomous Aquatic Animals

Sharks, barracuda, moray eels, needlefish, and coral present typical dangers of wounds and infections to persons venturing into the ocean. The injuries range from bites or stings to cuts, impalements, and abrasions. General Treatment Wound Management 1. If the bill or spine of an animal is seen to be lodged in the patient and has penetrated deeply into the chest, abdomen, neck, femoral region, or popliteal…

Scuba Diving–Related Disorders

Disorders related to scuba diving include those caused by environmental exposure (see Chapters 3 and 50 ), dysbarism, nitrogen narcosis, contaminated breathing gas, decompression sickness (DCS), and hazardous marine life (see Chapters 52 and 53 ; Box 51.1 ). Box 51.1 Medical Problems of Scuba Divers Problems Related to Environmental Exposure Motion sickness Drowning Hypothermia Heat illness Sunburn Phototoxic and photoallergic reactions Irritant and other dermatitis…

Membrane Transport

Cellular Transport: Passive and Active Mechanisms Ions and solutes move through several different types of carrier proteins and channels that allow solute movement through the plasma membrane in several different ways. The carriers and channels include: ▪ Ion channels and pores that allow diffusion of solutes between compartments. ▪ Uniporters , which are membrane transport proteins that recognize specific molecules, such as fructose. ▪ Symporters that…

The Cell and Fluid Homeostasis

Cell Structure and Organization Organisms evolved from single cells floating in the primordial sea ( Fig. 1.1 ). A key to appreciating how multicellular organisms exist is through understanding how the single cells maintained their internal fluid environment when exposed directly to the outside environment, with the only barrier being a semipermeable membrane. Nutrients from the “sea” entered the cell, diffusing down their concentration gradients through…

The Physiology of Aging

Biomedical science paid surprisingly little attention to a remarkable change in human biology during the 20th century—the marked increase of human life expectancy N62-1 in developed nations. Life expectancy is the projected mean length of life of those born in a given calendar year (e.g., 1984)—or those of a particular age (e.g., 30 years)—computed from the mortality characteristics of the entire population in a particular year…

Environmental Physiology

The earth and its atmosphere provide environments that are compatible with an extraordinary number of diverse life forms, each adapted to its particular ecological niche. However, not all the earth's surface is equally friendly for human survival, let alone comfort and function. Mountain climbers and deep-sea divers know the profound effects of barometric pressure (P b ) on human physiology, and astronauts quickly learn how the…

Exercise Physiology and Sports Science

Physical exercise is often the greatest stress that the body encounters in the course of daily life. Skeletal muscle typically accounts for 30% to 50% of the total body mass. Thus, with each bout of muscular activity, the body must make rapid, integrated adjustments at the level of cells and organ systems—and must tune these adjustments over time. The subdiscipline of exercise physiology and sports science…

Regulation of Body Temperature

Heat and Temperature: Advantages of Homeothermy Homeotherms maintain their activities over a wide range of environmental temperatures The ability to regulate internal body temperature has provided higher organisms independence from the environment. Because the rates of most physical and chemical reactions depend on temperature, most physiological functions are sensitive to temperature changes. Thus, the activity levels of poikilotherms (species that do not regulate internal body temperature)…

Metabolism

Metabolism encompasses all chemical reactions in the body's cells, necessary to sustain life. These chemical processes allow the body to grow, reproduce, maintain structure, and respond to changes in its environment. These processes can be anabolic, in which energy is used in the formation of substances such as proteins or nucleic acids, or catabolic, in which organic substances are broken down during cellular respiration to harvest…

Fetal and Neonatal Physiology

Fetal development is a highly organized process. The most rapid phase of growth transpires in at a degree of hypoxemia that mimics ascent to Mount Everest, while nutrients reach the fetus indirectly, from the maternal circulation. The transition to the extrauterine environment occurs abruptly and is likewise extraordinarily well orchestrated. Indeed, within a matter of seconds, the breathing infant can supply sufficient oxygen to the tissues…

Fertilization, Pregnancy, and Lactation

Transport of Gametes and Fertilization Cilia and smooth muscle transport the egg and sperm within the female genital tract Following ovulation, the fimbriae of the fallopian tube sweep over the ovarian surface and pick up the oocyte—surrounded by its complement of granulosa cells, the cumulus oophorus, and corona radiata (see p. 1122 )—and deposit it in the fallopian tube. Shortly after ovulation, movements of the cilia…

The Female Reproductive System

The female reproductive system functions to (1) pro­duce haploid gametes— ova, (2) facilitate syngamy —or fertilization—between an ovum and a spermatozoon, (3) supply a site for implantation of the embryo (if syngamy occurs) and the establishment of pregnancy, (4) provide for the physical environment and nutritional needs of the developing fetus and its timely birth, and (5) nurture the neonate. The system consists of the gonads…

The Male Reproductive System

The male reproductive system consists of two essential elements: the gonads (in this case the testes) and the complex array of glands and ducts that constitute the sex accessory organs ( Fig. 54-1 A, B ). Open full size image Figure 54-1 Anatomy of the male internal genitalia and accessory sex organs. A, The two major elements of the male sexual anatomy are the gonads (i.e.,…

Sexual Differentiation

Reproduction is a fundamental process of life. All living organisms must reproduce either asexually (e.g., bacteria) or sexually (e.g., mammals). Asexual reproduction is highly efficient and produces large numbers of genetically identical offspring in a relative short amount of time. This strategy, however, is vulnerable to environmental changes because genetic and phenotypic variation between individual progeny is minimal and consequently the probability of producing progeny that…