Dive into the world of wilderness medicine with thrilling discussions on the latest clinical guidelines for anaphylaxis treatment. Discover the challenges of managing allergic reactions in remote settings and the critical role of timely epinephrine administration. Explore the practical use of space blankets at high altitudes and innovative reflective foils for insulation. Celebrate the Full Circle Everest Expedition, highlighting the importance of representation and mentorship in climbing as they blaze trails for underrepresented communities.
Accurate diagnosis of anaphylaxis, requiring involvement of two organ systems, is crucial for effective treatment in wilderness settings.
Epinephrine is emphasized as the first-line treatment for anaphylaxis, working rapidly to ensure immediate relief during severe allergic reactions.
The Full Circle Everest Expedition highlights the importance of representation and mentorship in outdoor activities, empowering underrepresented communities in climbing.
Deep dives
Understanding Anaphylaxis Guidelines
The podcast presents new clinical practice guidelines on anaphylaxis, emphasizing the necessity of accurately diagnosing this life-threatening condition. Anaphylaxis requires involvement of two or more organ systems, including either respiratory or cardiovascular complications, to meet the clinical criteria for diagnosis. The speakers highlight the distinction between true anaphylaxis and other allergic reactions, such as those caused by poison ivy, which may not necessitate immediate epinephrine administration. They stress the importance of training medical practitioners to recognize these differences to ensure appropriate treatment and avoid unnecessary interventions.
The Role of Epinephrine in Treatment
Epinephrine is established as the first-line treatment for anaphylaxis, with discussions surrounding the necessity and timing of its administration in comparison to antihistamines and corticosteroids. The speakers clarify that epinephrine works on multiple fronts, including vascular constriction and bronchodilation, which are crucial during an anaphylactic reaction. They argue against the past belief that epinephrine's role was just to buy time for other medications to take effect, stating it is vital for providing immediate relief. Delays in administering epinephrine can lead to severe consequences, and the guidelines dictate that it should never be withheld for other treatments.
Biphasic Reactions and Evacuation Decisions
The conference underscores the risk of biphasic reactions, where symptoms may recur after initial treatment, necessitating careful observation of patients for extended periods. The speakers discuss factors influencing the decision to evacuate a patient after anaphylaxis, stressing that the risks depend on the severity of the initial allergic response and the patient’s overall stability. They recommend that individuals showing mild symptoms accompanied by a quick response to treatment may not need immediate evacuation under ideal conditions. However, if the symptoms were severe or multiple organ systems were involved, evacuation becomes critical.
Increased Awareness and Training
An increase in reported cases of anaphylaxis within wilderness activities has been attributed to greater awareness and improved training among instructors and participants. The speakers cite data showing a twelve-fold increase in recorded anaphylaxis cases over 15 years, with suggestions that this trend is linked both to rising allergy cases in the general population and a shift in perceptions about outdoor participation. They highlight the responsibility of instructors to be knowledgeable about allergies and treatments, fostering an environment where all participants feel confident and prepared. This awareness extends beyond clinical settings, influencing policies and enabling more inclusive practices for individuals with known allergies.
The Significance of the Full Circle Everest Expedition
An inspiring segment of the episode focuses on the Full Circle Everest Expedition, aiming to be the first all-Black team to summit Mount Everest. Led by Phil Henderson, this initiative not only symbolizes empowerment within the Black community but also seeks to mentor new climbers and foster broader participation in outdoor activities. The podcast explains that this initiative arises from a need for representation and mentorship, as historically, Black climbers have been underrepresented in the mountaineering community. The establishment of such teams highlights the importance of role models and encourages individuals from diverse backgrounds to engage more with outdoor adventures.
Please note: At approximately 26:45, there is a portion of updated audio to reflect the more commonly accepted dosing of IV epinephrine: diluting 1 mg of epinephrine in 10 cc of NS and giving 0.5 to 1 mL at a time. The technique and concentration in the edited audio are now also consistent with the published clinical practice guidelines.
#25: Anaphylaxis and Everest
March 2022
Wilderness & Environmental Medicine journal online: www.wemjournal.org
Questions/comments/feedback and/or interest in participating in WMP? Send an email to: wmpodcast@wms.org
Part 1: Journal Club
Title: Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis
Authors: Flavio G. Gaudio, David E. Johnson, Kelly DiLorenzo, Arian Anderson, Martin Musi, Tod Schimelpfenig, Drew Leemon, Caroline Blair-Smith, Jay Lemery
DOI: https://doi.org/10.1016/j.wem.2021.11.009
CME Available: https://wms.org/members
Presenters: Flavio G. Gaudio, David E. Johnson
Reviewer: Darryl Macias
Part 2: Discussion topics
• Darryl brings Ken Zafren onto the podcast to discuss the utility of “space blankets” in the wilderness medicine setting. See the article by Zafren et al, Prehospital Use of Ultrathin Reflective Foils, published in the March 2022 issue of WEM: https://doi.org/10.1016/j.wem.2021.11.006
• Darryl gives an update on the Khumbu Climbing Center and introduces us to the Full Circle Everest Expedition, the first Black climbing team attempting to summit Everest.
Audio editing: Tom Conklin (https://www.tomconklinvoice.com)
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