Ketamine Use in Wilderness Pain Management: An Interview with Dr. Chris Van Tilburg

In this episode of Wilderness Medicine Updates, host Patrick Fink discusses wilderness pain control with guest Dr. Chris Van Tilburg, focusing on the effective use of ketamine. The episode delves into how ketamine serves as a versatile medication for pain management, sedation, and intubation in emergency and wilderness environments.

Dr. Van Tilburg, an expert in wilderness medicine with extensive field experience, shares insights on administering ketamine in challenging rescue scenarios, the limitations and benefits of various medications, and practical considerations for field use. The conversation touches on dose ranges, administration techniques, and patient management during rescues. Additionally, Dr. Van Tilburg talks about his soon-to-be-released book, 'Crisis on Mount Hood: Stories from 100 Years of Mountain Rescue,' celebrating the centennial of the Crag Rats, America's oldest mountain rescue team.

Links
WMS Guideline: Avalanche and Nonavalanche Snow Burial

WMS Guideline: Pain Management in Austere Environments 

Chris’s Linktree

Contact Chris through LinkedIn

Preorder Chris’s book “Crisis on Mt Hood”

Chris on Wikipedia

Crag Rats Mountain Rescue

Chapters:
00:00 Welcome and New Year Greetings
00:29 Introducing Today's Guest: Dr. Chris Van Tilburg
03:07 Podcast Shoutouts and Listener Appreciation
03:37 In Conversation with Dr. Chris Van Tilburg
05:58 Challenges of Wilderness Pain Management
09:37 Pain Management Strategies
14:23 Ketamine vs. Other Pain Medications
18:01 Ketamine Dosage and Administration
22:16 Nitty Gritty Tactics: Needle Sizes and Administration
23:02 Intramuscular Injection Sites and Techniques
24:22 Timing and Dosage of Ketamine Administration
25:16 Challenges in Mountain Rescue Situations
27:17 Case Study: Seizure Patient and Ketamine Use
29:18 Considerations for Head Injuries and Ketamine
33:03 Medications in Wilderness Medical Kits
34:02 The Art of Wilderness Medicine
37:54 Protecting Medications in the Field
38:55 Wrapping Up: Upcoming Book and Final Thoughts

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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In episode 17 of Wilderness Medicine Updates, host Patrick Fink delves into the ICAR resuscitation algorithm for buried avalanche victims. The episode reviews the physiology of avalanche burial and discusses critical determinants of survival, such as duration of burial, airway patency, signs of life, and lethal injuries. The Basic Life Support (BLS) and Advanced Life Support (ALS) algorithms are explained in detail, with a focus on the practical application for both amateur and professional rescuers.

The episode also includes two detailed case studies that illustrate the application of the resuscitation algorithm, providing listeners with practical scenarios to better understand the protocols. Key insights on the importance of quick action, hypothermia, and ongoing CPR are highlighted, making this episode essential listening for anyone involved in avalanche rescue operations.

Ep. 12 - Resuscitation of the Buried Avalanche Victim, Part 1: Physiology

ICAR Rescue Algorithm

ICAR Paper in Resuscitation

Chapters:
00:00 Ep. 17 - Resuscitation of the Buried Avalanche Victim, Part 2
01:26 Review
08:52 BLS Algorithm
14:30 ALS Algorithm
25:30 Interlude
25:30 Case 1: Partner Rescue
31:01 Case 2: Professional Rescue
39:54 Conclusion/Outro

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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In this episode, I share an intense story of dealing with a suprise medical condition during a backcountry hut trip in Colorado. I walk through the diagnostic process, treatment options, and the importance of preparation for stays in remote places. Essential medications and tools needed for handling such emergencies in remote settings are discussed, along with advice on how to prepare for future expeditions.

My articles on The-High-Route.com

The Hut Medication Card

Chapters: 

00:00 Introduction and Personal Update

01:31 The Backcountry Hut Trip Begins

03:19 Will's Health Deteriorates

04:38 Diagnosing the Problem

07:04 The Emergency Descent

09:16 Lessons Learned and Preparedness

10:37 Essential Medications for Wilderness Trips

16:19 Final Thoughts and Conclusion

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

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This episode, I look at a study from the Eurac research group on rates of airway occlusion in critically buried avalanche victims. Eurac looked at this critical feature of avalanche resuscitation triage as it both affects the way we treat buried avalanche victims, and it helps us to better understand whether technologies like the black diamond Avalung (retired) and the Safeback SBX can help us survive longer under the snow if buried.

Full study text HERE

The High Route article on the Safeback system HERE

Episode 12: Avalanche victim physiology. Listen on web, Apple Podcasts, or Spotify.

Episode 14: Spinal immobilization updates. Listen on web, Apple Podcasts, or Spotify.

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].

You can pay us a compliment and share the show with a new listener on any popular platform here.

Today, we discuss updates in the WMS guidelines regarding the protection of patients with suspected spinal injuries.

The Wilderness Medicine Society Clinical Practice Guidelines are all open-access, and you can find links to all of these guidelines on the right sidebar of this page.

The education in this episode is based on the:

If you've never seen a vacuum mattress before, this video (2:10) gives a good introduction.

If the brief mention of the Diploma in Mountain Medicine alpine skills course got you interested, you can learn more about the DiMM here.

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].

You can pay us a compliment and share the show with a new listener on any popular platform here.

This episode is a repost of an interview that was first posted on The High Route Podcast. Hosted by the editor of The-High-Route.com, Jason Albert, we discuss my background in wilderness medicine, and then move on to discuss the research that support my argument and assertion that the avalanche airbag backpack should be standard equipment for backcountry skiers, snowboarders, snowmobilers, and anyone who regularly works or recreates in avalanche terrain.

Check out The-High-Route.com for awesome backcountry ski and ski-mountaineering content that is unbiased by financial relationships with gear companies and advertisers.

Show Note Links:

-ISSW Research Manuscript from my avalanche airbag study

-My personal website, Mountain Lessons

-The Backcountry Shit Kit, original post

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].

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This is part 1 of a multi-part series on the resuscitation of critically buried avalanche victims. In this episode we learn the physiology that we need to understand the resuscitation algorithm. To learn the necessary biology, we follow a rider as they are carried in an avalanche, subjected to traumatic injury, and are then buried and begin to asphyxiate and cool. 

The background of this episode is useful to understand why:
-Cardiac arrest from trauma is usually unsalvageable;
-Arrest due to hypoxia can happen within minutes or be delayed more than an hour;
-Why we care if someone is really, really cold;
-Why potassium measurement is useful in the hospital treatment of severe hypothermia;
-And why we can largely forget about that other gas, CO2.

Look out for the next episode, where I''ll dive into the ICAR Avalanche Victim Resuscitation Algorithm.

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].

You can pay us a compliment and share the show with a new listener on any popular platform here.

Episode 11 brings you  my conversation with Michael Buchanan is a flight paramedic and senior firefighter / paramedic at the West Valley City Fire Department. He is the founder and operation of Mountain Medical Academy, a passion-driven backcountry medical care education company.  We discuss the medical care of avalanche victims which Michael has made accessible to recreational skiers and riders who don't have a medical background.

Other topics that we discuss include:
-Finger sweeps to clear the airway
-How the presence of an air pocket changes your medical care
-How long to perform CPR after an avalanche
-What equipment may be useful to a lay rescuer
-The importance of psychological care after a critical event
And more.

Below are links to things discussed in this podcast:

Mountain Medical Academy - mountain medical education

After the Avalanche - Open source resources for responding medically and psychologically after an avalanche

Email Michael to Join a Class or Partner Up

Israeli Battle Dressing (affiliate link) - elastic compressive dressing for bleeding control

SWAT-T Elastic Tourniquet (affiliate link) - elastic tourniquet also useful in splinting

CPR Mask / Oral / Nasal Airways (affiliate link) - tools for rescue breathing / CPR

ICAR Avalanche Resuscitation Recommendations for advanced life support personnel

Responder Alliance - individual and organizational resilience for rescuers in the face of traumatic stress.

Not Alone complete film - Sarah Hueniken - a personal story of recovery from stress injury and trauma by a world class ice climber. 

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode, I discuss the article "Arterial Occlusion Effectiveness of Space Blanket-Improvised Tourniquets for the Remote Setting". In this short blast I get into the meat of this article, and though the authors would tell you that space blankets aren't ready for primetime, I have some thoughts on the matter.

In the podcast, I mistakenly say that you need to be a WMS member to access this article, but you don't! It's available open access here:

https://www.wemjournal.org/article/S1080-6032(23)00043-1/fulltext

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].

You can pay us a compliment and share the show with a new listener on any popular platform here.

In this episode Dr BZ is back to talk about his experience deploying with the Federal Emergency Management Agency (FEMA) Urban Search and Rescue Task Force (USAR). Dr BZ just returned from a deployment with FEMA USAR to Lahaina, HI, where he served as a team physician supporting rescue and recovery efforts there.

We touch on:
-Training and gear
-Deployments and schedule
-Compensation
-The care of canines
-How you can get involved, and more!

As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM.

Connect with us by email at [email protected].

You can pay us a compliment and share the show with a new listener on any popular platform here.