Brazilian pepper, Schinus terebinthifolius,

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ISSN:1059-6518 Volume 29 Number 3

By Brandon Munsell NREMT-P , WEMT-P, SOLO Instructor

As the campfire kicks into high gear, a camper throws on boughs from a nearby tree. Although the tree limbs seem dead, the tree they were taken from is abloom with bright red berries and serrated toothed leaflets. As the now burning branch begins to spew smoke, a wind directs it towards gathered campers. Upon inhalation the members begin to experience irritation to their faces and throats, and they also begin to tear up as they assume tripoding positions to catch their breath. As they retreat from the offending fumes, many begin to wheeze and seek water for their now burning eyes. What has caused this unexpected reaction?

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By Frank Hubbell, DO

Illustrations By T.B.R. Walsh

Places where you used to only see the intrepid adventurer you are now seeing more and more families. These families are recreating with all ages, including the very young. So it seemed like the time was right to review pediatric medical emergencies and management of them in the wilderness environment.

The Principles of Managing Pediatric Medical Emergencies:

Children are not small adults.

A child’s physiology varies greatly based on age and body weight.

A child’s emotional response to a crisis varies greatly with age.

A child’s mental capacity and understanding vary greatly with age.

A child’s speech and communication skills vary greatly with age.

Responding to a Pediatric Emergency – the Pediatric Patient Assessment System:

Initial Impression (PAT) ➡️ Primary Survey ➡️ Secondary Survey

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The Challenges of Emergency Airway Management:

 By Frank Hubbell, DO

Illustrations by T.B.R. Walsh

First, let’s define the problem:


1.     When the need for emergency airway management arises, it is usually a scene that is already difficult, desperate, rapidly deteriorating. A scene that most likely requires critical care skills. One of those rare times where speed is of the essence.

2.     Your patient may be unruly, uncooperative, or even intoxicated.

3.     Your patient will most likely already be hypoxic with poor oxygenation and decreasing respiratory and ventilatory efforts. As a result they will not tolerate even short periods of apnea or hypoxia.

4.     Your patient may have recently eaten or drank, and these stomach contents dramatically increase the risk of vomiting and with the risk of aspiration.

5.     Their airway may already be compromised by blood, vomitus, secretions, or distorted anatomy from trauma.

6.     Your patient may be a cardiac arrest or a near-arrest situation.


OXYGEN: Let’s begin this discussion with oxygen.


When we talk about the importance of maintaining an open airway, what we are really talking about is the importance of a constant, uninterrupted flow of oxygen to every cell in the body. The cells with the greatest demand, and therefore the most sensitive tissues to oxygen supply, are the nerve cells that make up the brain. These neurological tissues can only survive intact for 4 – 6 minutes without oxygen; after 10 minutes without

O2 , irreversible brain damage occurs and most likely death.


The human brain makes up 2% of our total body weight, but it is hypermetabolic:

– it requires 15% of our cardiac output,

– 20% of total body oxygen consumption, and

– 25% of the total body utilization of glucose.

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Volume 26 Number 4

By Frank Hubbell, DO

Illustrations By T.B.R. Walsh


To be used on anyone who is exhibiting signs and symptoms of hypoxia:


Shortness of breath

Increase or decrease in respiratory rate

– Adult: respiratory rate less than 10 or greater than 30

– Child (1 year – 12 years old): respiratory rate less than 15 or greater than 30

– Infant (0 – 12 months old): respiratory rate less than 25 or greater than 50

Increase in heart rate.

Change in level of consciousness.

Change in skin color: pallor or cyanosis.


 Never, ever withhold oxygen from someone who appears to need it.

The following is needed to provide supplemental oxygen to a patient:

✔  O2 tank

✔  Regulator

✔  Delivery device – O2 mask


 Medical Oxygen Storage Tanks:

Come in various sizes.

Are identified by color– either the entire tank is green or the curved part of the tank, “the shoulder,” is green

Have an identifying yellow, diamond shaped label on the tank that is marked U.S.P. and Oxygen

Full tanks contain 2000 PSI of pressure and must be handled properly.


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