health

Dirty Genes by Ben Lynch

The Big Idea: most chronic health problems are caused by impaired gene expression — which can be fixed by eating and living clean.

  • Epigenetics is the process of turning genes on and off.
  • Our genetic destiny isn’t fixed. Genetic expression is affected by our environment and our lifestyle choices (diet, exercise, sleep, stress, pollution.)
  • Most doctors are trained to treat symptoms, usually by prescribing some medication.
  • Functional medicine doctors aim to understand the root cause of symptoms. Dirty genes are likely at the root of your health problems.
  • Your genetic expression can be disrupted by poor diet, including factory-farmed food, lack of exercise, too much exercise, not enough sleep, environmental toxins, and plain old everyday stress.
  • Your genetic expression can be disrupted by medication. If you’re taking antacids, for example, you’re messing with many major genes, including MTHFR, MAOA, and DAO. If you’re taking metformin, a common medication for diabetes, you’re disrupting the function of your MAOA and DAO. Birth-control pills, hormone replacement therapy, and even bioidentical hormones can strain your MTHFR and COMT.
  • Your genetic expression can be disrupted by environmental toxins: sprays, cleaners, cosmetics, paints, pesticides, herbicides.
  • Most lab test results are expressed in terms of ranges that are based on the “average healthy person” — who is actually not very healthy!
  • There are two types of dirty genes: born-dirty genes (single-nucleotide polymorphisms or SNPs) and dirty-acting genes (genetic expression). You can support both types through better lifestyle choices.
  • When you clean up your dirty genes, you start feeling terrific in ways you never even imagined.
  • To clean your genes: eat organic whole foods, avoid refined carbs, filter your water, avoid chemicals, clean up the air you breathe, sleep well, exercise regularly, and reduce your stress.
  • When you support your genes with the right diet, exercise, sleep, protection from chemicals, and stress relief, your born-dirty genes are much more manageable. When your body and/or mind undergoes stress, all your genes get dirty, and your born-dirty genes start to give you trouble.

SEVEN KEY GENES

Seven gene SNPs most likely to have the biggest impact on your health:

  1. MTHFR: the methylation master gene
  2. COMT: help determine whether you’re focused and buoyant, or laid-back and calm
  3. DAO: makes you supersensitive to certain foods and chemicals
  4. MAOA: affects mood swings and carb cravings
  5. GST/GPX: can create detox dilemmas
  6. NOS3: can create heart issues
  7. PEMT: supports your cell membranes and liver

SEVEN KEY GENES: DETAIL

  1. MTHFR: supports methylation, which is critical in countless other pathways; avoid folic acid; ensure consumption of folate from leafy greens; filter your drinking water; get enough B12; get deep restorative sleep.
  2. COMT affects metabolism of dopamine, norepinephrine, and epinephrine, affecting your mood; slow COMT means you can’t clear these biochemicals quickly; fast COMT means you clear these biochemicals too quickly; reduce visceral fat; optimize micronutrients; avoid plastic; meditate; have a regular sleep/wake routine; avoid the herbicide Roundup (and non-organic soy); eat organic if possible; avoid sugar and refined carbs; sweat out toxins in a sauna.
  3. DAO affects your body’s response to histamine from food and bacteria, which in turn affects your vulnerability to allergy; avoid old leftovers; gut imbalances can affect gut tight junctions and result in chronic inflammation; eat foods that build a strong gut microbiome; too much histamine in your gut can cause acid reflux and heartburn; DAO needs calcium and copper; optimize sleep and reduce stress; the real problems behind depression are inflammation and stress.
  4. MAOA affects dopamine, norepinephrine, and serotonin, governing your mood, energy level, and ability to sleep; stress reduction belongs at the very top of your list; dirty MAOA sets you up for tremendous mood swings; MAOA needs riboflavin and tryptophan; eat healthy carbs and healthy fats every meal.
  5. GST/GPX enables detoxification; industrial chemical and heavy metals lead to serious chronic disease; glutathione is your body’s chief detox agent; protect your gut microbiome; reduce stress; make sure you are getting riboflavin/B2, selenium, cysteine; low glutathione results in extra body fat and impaired levels of dopamine, serotonin, and nitric oxide; low glutathione puts you at risk for cardiovascular disease and autoimmunity; fiber is good for your gut microbiome; check your home for mold; sweat in the sauna; eat broccoli sprouts.
  6. NOS3 affects circulation, which helps determine your cardiovascular health; low nitric oxide can affect platelets and increase clot formation; low nitric oxide impairs angiogenesis; avoid unhealthy chemicals; low nitric oxide can lead to birth defects; diabetes can impair NOS3; avoid stress, smoke, and pollution; avoid folic acid; leafy greens has lots of folate; get calcium, iron, riboflavin/B2, arginine from natural foods; treat sleep apnea, ideally by losing body fat;
  7. PEMT affects your cell walls, brain, and liver, determining a wide range of health issues; malfunctional PEMT leads to fatty liver; impaired PEMT leads to nutrient deficiency regardless of consumption; PEMT also helps produce choline/acetylcholine; phosphatidylcholine is needed for good bile flow; consume choline through liver, eggs, fish, chicken, red meat; support MTHFR and methylfolate; eat eggs, leafy greens, avocado oil, ghee; avoid refined carbs; limit alcohol and food preservatives.

  • Clean all your genes, all the time. Make it a daily ritual! Find out which born-dirty genes might need some extra support, and give that support to them.
  • Here’s the bottom line: the only way to truly help your dirty genes is by remaining on the Clean Genes Protocol, a lifelong approach to diet and lifestyle.

Unconventional Medicine by Chris Kresser

The Big Idea: Most chronic disease is preventable, and much of it is reversible, if a comprehensive, individualized approach, called “Functional Medicine,” is followed.

Ch 1: Leo’s Story

Most doctors, and by extension patients and the public, have no idea that mental and behavioral disorders can have physiological causes.

Ch 2: From Band-Aids to True Healing

Book: Nourishing Traditions by Sally Fallon

Ch 3: If Not Now, When? If Not You, Who?

Ch 4: Chronic Disease, A Slow-Motion Plague

Our lifespans have increased.

The projected decrease in life expectancy has been attributed mostly to the explosion of chronic diseases like obesity and diabetes in children.

As recently as the 1950s and 1960s, obesity was rare.

One in two Americans now has a chronic disease, and one in four has multiple chronic diseases.

The U.S. spends $3.2 trillion a year on healthcare. This is equivalent to 18% of our GDP.

50 million Americans (one in six) have an autoimmune disease.

Alzheimer’s is now the sixth leading cause of death in the U.S.

One in 45 children now has autism spectrum disorder.

Ch 5: Three Reasons U.S. Healthcare Is Destined to Fail

There’s little motivation for insurance companies to embrace treatments that would ultimately shrink spending on health care.

Pharmaceutical company’s work and products may be more focused on making money.

Two-thirds of medical research is sponsored by pharmaceutical companies.

This is not evidence-based medicine, it’s reimbursement-based medicine.

There are three much deeper reasons that healthcare in the U.S. is doomed to fail:

  1. Our modern diet and lifestyle are out of alignment with our genes and biology.
  2. Our medical paradigm is not well-suited to tackle chronic disease.
  3. Our model for delivering care doesn’t support the interventions that would have the biggest impact on preventing and reversing chronic disease.

Human beings lived most of our history eating a hunter-gatherer diet and living a hunter-gatherer lifestyle.

Our ancestors walked an average of 10,000 steps a day.

Conventional medicine is structured to address trauma, acute infection, and end-of-life care, not to keep people healthy.

Seven of the top ten causes of death are chronic diseases.

Unlike acute problems, chronic diseases are difficult to manage, expensive to treat, and usually last a lifetime.

Another reason that conventional medicine hasn’t been successful is that it focuses on suppressing symptoms rather than addressing the underlying cause of disease.

“The wise physician treats disease before it occurs,” according to the Traditional Medicine proverb.

The average visit with a PCP in the U.S. lasts for just ten to twelve minutes.

Patients get to speak for only twelve seconds on average before being interrupted with advice from their physician.

Ch 6: The Toll, How Conventional Medicine Affects Healthcare Providers

Both doctors and patients feel dissatisfied with how little time gets spent on doctor-patient visits.

After inflation, primary care doctors earn somewhat less today than they did in 1970.

Almost half of physicians are thinking of quitting medicine, cutting back hours, switching to concierge medicine, or taking other steps to limit patient access.

Ch 7: A New Model, The ADAPT Framework

It’s not normal for human beings to develop chronic disease.

A Functional Medicine approach is focused on preventing and reversing, rather than simply managing, chronic disease.

An ancestral diet and lifestyle reflects the recognition that we are evolutionarily mismatched to our environment and that this mismatch is the primary driver of chronic disease.

The ancestral diet and lifestyle — though extremely effective in most cases — was often not enough to completely reverse the patient’s health problems and restore optimal function. So Functional Medicine offers a more comprehensive toolset.

Ch 8: The Paradigm Shift, Functional Medicine as True Healthcare

Conventional medicine is mostly about trying to bail water out of the boat without fixing the leaks.

Functional Medicine seeks to get to the bottom of things. It looks for the underlying cause of disease.

At the core of the model is the relationship between the Exposome, our genes themselves, and the way our genes express themselves over time.

Pathologies are the underlying mechanisms that give rise to diseases and syndromes.

A disease is more clearly defined and characterized than a syndrome because it has specific signs and symptoms and the causes are more clearly defined and understood.

A sign is an objective indication of a disease or syndrome that can be observed during a physical examination or through laboratory testing.

Symptoms are the subjective experiences that the patient might report to the clinician.

After analyzing the Exposome layer, we examine pathology.

Conventional medicine is well-suited for dealing with acute, infectious disease, trauma, and injuries. However, it falters in addressing chronic disease, which is the biggest health problem we face today.

Within conventional medicine, pharmaceuticals are the primary treatment for almost 90 percent of all chronic conditions.

Conventional medicine is not truly healthcare — it’s disease management.

Functional Medicine, on the other hand, is designed to promote health.

A patient’s behavior is one of the biggest, if not the biggest, contributors to chronic disease.

Conventional medicine views the body as a collection of separate parts.

Specialists infrequently consult with each other or acknowledge the important connections between the body’s various parts.

Functional Medicine is often much more affordable than conventional medicine, largely because it seeks to prevent and reverse disease, rather than just manage it.

Although the upfront cost may be higher, Functional Medicine would save an enormous amount of money over this patient’s lifetime, because it would prevent diabetes before it occurred in the first place.

Conventional medicine tends to be more allopathic in its approach, and relies almost exclusively on drugs and surgery. Although most doctors acknowledge the importance of diet and lifestyle, the model isn’t structured to support patient change in those areas.

Drugs and surgery can cause serious side effects and complications, including death.

Medical care is the third leading cause of death in this country.

Cleveland Clinic was the first major organization to recognize the power of Functional Medicine. They tapped Dr. Mark Hyman to create a Center for Functional Medicine within Cleveland Clinic.

Dr. Bredesen addresses dementia and Alzheimer’s disease from a holistic—functional—perspective. When a patient comes to see him, he doesn’t simply administer memory tests. He investigates the patient’s gut function. He measures their blood sugar. He examines their diet and their nutrient status. He considers heavy metal toxicity, mold, and biotoxins. He analyzes methylation. He looks at detoxification.

Dr. Terry Wahls was diagnosed with multiple sclerosis. She wrote The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles.

In Functional Medicine, we start by asking why the couple is having trouble getting pregnant. The possibilities include nutrient deficiency, thyroid problems, sex hormone imbalance, inflammation, insulin resistance and blood.

We almost always start with the foundational layer — diet, lifestyle, and environment. That’s especially true for chronic illnesses.

Ch 9: Realignment, Matching Our Environment With Our Genes

Humans evolved in a vastly different environment than the one we’re living in now.

Our genes are hard-wired for the twenty-four-hour light-dark cycle.

Modern diseases that countless people suffer from today, like heart disease, diabetes, and many autoimmune diseases, are nearly nonexistent in hunter-gatherer populations.

When hunter-gatherer cultures have access to even the most rudimentary form of emergency medical care, like a clinic half-a-day’s hike away, they live lifespans that are roughly equivalent to our own, particularly if they’re living in a relatively secure, peaceful environment.

Epigenetics is probably much more important than the genes themselves, in terms of determining our susceptibility to chronic disease.

For 77,000 generations, the human diet consisted primarily of meat and fish, some wild fruits and vegetables, nuts and seeds, and some starchy plants.

Ancestral populations generally got at least seven to eight hours of sleep a night.

Hunter-gather societies walked an average of 10,000 steps a day.

Ancestral humans lived in close-knit tribal and social groups, with multiple generations.

Ancestral humans generally “worked” about three to four hours a day.

Chronic inflammation is insidious; it often affects multiple tissues. If someone is eating an inflammatory diet and living an inflammatory lifestyle, that could cause a wide range of symptoms.

Ch 10: The 21st Century Practice, A Collaborative Model

The conventional system is buckling under the weight of misaligned incentives, broken payment models, inefficiency and bureaucracy, and a paradigm that is not well-suited to address chronic disease.

Many clinicians are choosing to move to a cash-only or a cash-plus-insurance practice.

Insurers are beginning to recognize the value of telemedicine; video conferencing is now reimbursed in many states, and others are moving in that direction.

One area of dissatisfaction and pushback among doctors is with electronic health records (EHRs). Initially, there was a lot of enthusiasm for EHRs, but the way they’ve been implemented in conventional medical settings has been horrific.

Ch 11: Regarding Evidence

Two-thirds of medical research is funded by pharmaceutical companies.

Abilify, for example, is one of the best-selling drugs in the United States. It was originally developed as an anti-psychotic, and is approved for schizophrenia, bipolar disorder, depression, and autism spectrum disorders.

The humility to admit when we’ve been wrong is essential to good science. Unfortunately, in the conventional medical paradigm, this willingness and humility have often been replaced by groupthink, arrogance, and a stubborn attachment to the status quo.

What does the research say about Functional Medicine?

The gold standard of conventional research — the randomized clinical trial — isolates just one variable, then tests the effect of that variable; all other elements of the study are kept the same. The randomized clinical trial is practically the antithesis of the philosophy of Functional Medicine, which seeks to tailor layered treatment plans to individual patients.

Attending conferences and continuing education classes can help doctors stay current, but those conferences are often sponsored by a drug company.

Unfortunately, much of the research we’ve formerly relied upon was never replicated.

The latest research often takes time to reach practicing clinicians—and their patients.

Ch 12: ADAPT in Practice, Four Common Conditions

Most commonly prescribed drugs are just palliative — in other words, they offer some relief for symptoms but don’t address the underlying cause.

In a conventional model, the doctor would simply issue his or her recommendations: “Okay, eat better. Exercise more. Do this protocol.” The patient would walk away and then likely struggle or fail to follow through.

Patients need to recognize that the system is set up to support and subsidize drugs.

Ch 13: ADAPT in Practice, The Practitioner’s Experience

Ch 14: ADAPT in Practice, The Patient’s Experience

Although Functional Medicine will almost certainly prove more cost-effective than conventional medicine over time, right now out-of-pocket expenses are higher for Functional Medicine because of the lack of insurance coverage.

It’s worth noting that conventional care can be enormously expensive for patients since it relies heavily on medications, surgery, and other expensive procedures. Insurance provides some relief but doesn’t always cover these expenses — and when that happens the results can be disastrous. One in five Americans struggle to pay medical bills each year. Three in five bankruptcies are due to medical expenses.

Ch 15. The Future of Medicine

The factors that most predict your health are your wealth, education, and lifestyle — not your access to healthcare.

Today, we spend 86 percent of our healthcare dollars on treating chronic disease but just three percent on public health measures.

The launch of Cleveland Clinic Center for Functional Medicine has served to open many people’s eyes to the potential of this model.

Dr. Mark Hyman, the clinic director, travels all over the world to educate people about Functional Medicine.

Ch 16: Next Steps: Three Things to Do Now

Ch 17: Resources for Practitioners & Patients

Institute for Functional Medicine (IFM)

Kalish Institute

RobbWolf.com

DrHyman.com

SaraGottfried.com

Paleo f(x)

Revolution Health Radio

The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline

The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles

Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain — for Life

The Sleep Revolution by Arianna Huffington

95% of this book was about why sleep is so important.

5% of the book is about how to get better sleep.  Save time by reading this article instead.

THE BIG IDEA

More and better quality sleep will make your life better.  Exercise. Meditate. Avoid caffeine after 2pm.  No digital devices near bedtime. Keep your bedroom cool.

KEY TAKEAWAYS FROM THE SLEEP REVOLUTION

  • Lack of sleep weakens your immune system, can make you fat, can make you depressed, and hurts your decision making.
  • Sleeping pills are terrible for you.
  • No coffee after 2pm.
  • Dreams can often be the source of good ideas, so keep a dream journal by your bed.
  • Snoring might be a sign of sleep apnea, which can disrupt REM sleep and make you perpetually exhausted.
  • Lucid dreaming helps some people overcome night terrors.
  • Get 7-9 hours of sleep every night.
  • Some couples sleep in separate beds and still maintain a happy relationship.
  • Turn down all light an hour or two before going to bed.
  • No digital screens allowed in bed.
  • Ideal sleeping temperature is 60-66 degrees.
  • Exercise at some point during the day will improve that night’s sleep.
  • Eat dinner at a reasonable time.
  • Avoid spicy foods before bed.
  • Alternative remedies can help but ignore alternative remedies until you get the basics handled: acupuncture, chamomile, lavender, GABA.
  • Reduce your stress with yoga, meditation, or qigong.
  • Write down your blessings before bed.
  • Write down your todo list before bed.
  • Naps are fantastic for your body and mind.

Basic Wilderness Life Support

This was from a wilderness medicine course I took at BCM.

The Big Idea: boil all water, clean wounds with soap and water, wash off poison ivy within 1-4 hours, do not suck out snake venom, splint possible fractures, seek medical attention 

Essentials for Wilderness Travel

  • map, compass, knife, matches, flashlight, first aid kit, sunglasses/sunscreen, extra food, extra clothes, water
  • first aid kit/prevention: blister prevention, insect repellant, gloves
  • first aid kit/procedures: splint, scissors, duct tape, zip lock bags, safety pins, tweezers, syringe
  • first aid kit/medication: topical antibiotics/antiseptics, tylenol, imodium, benadryl, hydrocortisone cream, aloe, antifungal, epipen
  • first aid kit/wound: gloves, bandaids, irrigation, wound closure strips, moleskin, povidone-iodine, benzoin, dressings, antiseptic towelletes, alcohol swabs, gauze, antibiotic ointment, Ace bandage, Q-tip, triangular bandage
  • vehicle first aid kit: large burn dressings, rope, splints, blankets, radio, shovel, chains, food, water, fire extinguisher, candle, saw, flares

Water

  • use screen (bandana) to remove debris
  • let water stand for debris to settle, then decant from the top
  • boil to kill hep A, bacteria, enteric viruses, crypto, giardia
  • if you can’t boil, filtration works for all except viruses
  • if you can’t boil, chemical disinfection (iodine/chlorine) works for all except helminths and protozoa
  • chlorine dioxide is highly effective against all

Assessment

  • ABCDE: airway, breathing, circulation, disability, environment
  • if not breathing, CPR: 30 chest compressions, 2 rescue breaths
  • never move a victim with possible spinal injuries, unless you have to

Wounds

  • abrasions: minimal blood loss, painful, foreign objects
  • lacerations: high risk of infection, foreign objects, animal bites
  • first degree burn: red, treat with aloe, damp cloth
  • second degree burn: blistered, treat with cool water, antibacterial ointment, dressing, possible evac
  • third degree burn, victims of fires: all layers burned, nerve damage, possible reduced pain, evac
  • 1st treatment for bleeding: direct pressure for several minutes, longer for scalp wounds
  • 2nd treatment for bleeding: after direct pressure, pressure points (axillary artery, femoral artery) and elevation
  • tourniquet: last resort for bleeding, may result in amputation, tie a cloth around limb and tighten by turning a stick through the knot
  • irrigate wound with lots of clean water to help prevent infection
  • remove foreign matter from wound if possible
  • don’t worry about closing a wound, worry more about irrigating and dressing it well
  • use tape to close a cleaned and irrigated wound
  • dressing: antibiotic/antiseptic ointment, dressing, gauze, tape
  • check dressings 1-2x daily for infections
  • alternative topical antimicrobial: unprocessed honey
  • scrub abrasions well, even if painful
  • keep thumbs and fingers for possible re-implantations, keep cold but do not ice directly
  • lacerations to eyelids, ears should evac
  • deep lacerations to limbs: test strength, full range of motion, sensation, for possible tendon and nerve damage
  • puncture wounds: don’t forcefully irrigate or might push in debris, scrub and dress, do not close, evaluate frequently for infections
  • bites: clean very well, look for debris, evaluate frequently for infections
  • blister: okay to puncture large blisters

Sprains, Dislocations, and Fractures

  • sprain: stretching or tearing of ligaments, knee/ankle, similar symptoms to fracture
  • dislocation: bone pulled out of its socket, shoulder, elbow, finger, kneecap, compare joint to the uninjured side
  • fracture: closed vs open, difficult to diagnose without X-rays
  • sprain/fracture: assume it’s fractured, splint, evac
  • neck/back, pelvic, femur fractures: very serious, helicopter evac
  • splinting: remove jewelry before swelling, recheck circulation and sensation after splinting
  • sprain: RICES for 72 hours (rest, ice, compression, elevation, stabilization)
  • dislocations: reduce if you know how, otherwise evac

Drowning

  • drowning: body involuntary breathes, water enters lung, lung injury, decreased oxygen to brain, death if not rescued
  • pass out after 3 minutes, brain damage after 5 minutes
  • CPR if victim not breathing: 2 rescue breaths, 30 chest compressions
  • no special drainage procedures to empty water out of the lungs or stomach
  • if no symptoms, observe victims for 6 hours

Medical Problems

  • chest pain: rest and take a history (OLDCARTS), if in doubt chew aspirin and evac
  • shortness of breath: rest and take a history (OLDCARTS), if no resolution evac
  • seizures: let it run its course, after it stops roll patient on side, first time seizures (low blood sugar, head injury, CNS infection, toxicity, stroke) require rapid evac
  • stroke: lack of blood flow to the brain, helicopter evac
  • diabetes/low blood sugar: clammy skin, weakness, confusion, give sugar and evac
  • Read up from a reliable resource about CPR, and about heart attack prevention
  • diabetes/high blood sugar: confusion, blurry vision, nausea, fruity smelling breath, give lots of fluids with electrolytes, evac
  • local allergic reaction: cold packs, hydrocortisone cream, benadryl
  • generalized allergic reaction: epipen+benadryl
  • abdominal pain: too many possible causes so just evac

Bites and Stings

  • get your tetanus vaccination
  • all wounds: irrigate with water, clean with soap and water, dress with clean cloth
  • dog/cat bites: consider oral antibiotics
  • wild animal attacks in the US are rare
  • rabies: skunks, raccoons, foxes, bats
  • black bear: try to scare away, if attacked get into fetal position
  • brown bear: stand quietly, do not run, if attacked get into fetal position
  • cougar: do not run away, try to scare off, pick up children
  • snakes (pit viper): mostly hemotoxic, support airway/breathing/circulation, evac, bite kits ineffective, do not tourniquet, do not use alcohol, do not use aspirin, do not ice
  • snakes (coral): red on black venom lack — red on yellow kill a fellow, wrap limb tightly in elastic bandage
  • mosquitos: most active at dusk, use DEET, put campsite should be high and away from standing water
  • spiders (black widow): catch the spider, clean the bite with soap and water, evac
  • spiders (brown recluse): painless bite, swollen after 2-8 hours, catch the spider, clean the bite, look for white core with white/blue border, elevate limb, systemic signs means get to hospital
  • spider (hobo): brown spider with yellow green dorsal abdomen, no need to evac unless systemic symptoms
  • ticks: remove ticks within 48 hours to prevent Lyme, use twizzers only
  • ants/bees/wasps: treat generalized allergic reactions with epipen
  • scorpions: only bark scorpion is dangerous, clean sting, apply ice and oral pain meds, rapid evac if bark scorpion
  • jellyfish/man-o-war: rinse with seawater/vinegar (except man-o-war)/alcohol, do not use freshwater/rub/warm water
  • sea snake: begins painless, then aches and fatigue within 2-3 hours, immobilize limb, no ice, no suction, no incision, rapid evac
  • poison ivy/oak/sumac: poison ivy = leaves of three let it be, never burn the leaves, watch with soap and water within 1-4 hours, hydrocortisone cream asap (except face/genitals), benadryl/calamine for relief

Lightning

  • most common cause of death in a lightning victim is cardiopulmonary arrest
  • continue to give rescue breathing once a victim recovers a pulse because drive to breathe is often delayed
  • treat unconscious/no-pulse/no-breathing victims first (reverse triage)
  • no need to worry about touching a lightning strike victim
  • avoid being the tallest object in an open field
  • avoid being next to the tallest object in an open field
  • seek shelter in a low area under small trees
  • avoid open doors and windows, metal objects

Heat Injuries

  • heat cramps: oral salt replacement and hydration
  • heat fainting: lie the victim flat so blood can flow back from legs to brain
  • heat exhaustion: cool victim and rehydrate
  • heat stroke: emergency, lack of active sweating, CNS disturbance, ice packs, evaporate cooling, rapid evac

Cold Injuries

  • hypothermia: rewarm the patient
  • cold rescue: no one is dead until they are warm and dead
  • frostbite: elevate the extremity, thawing and rewarming should be done by a doctor, doctor will rapid rewarm with warm water not fire
  • trenchfoot: rewarm foot, resolves spontaneously

Altitude Sickness

  • acute mountain sickness: rest, tylenol
  • high altitude cerebral edema: unsteady gait, fatigue, immediate descent and evac, full recovery can take weeks
  • high altitude pulmonary edema: shortness of breath at rest, immediate descent and evac