ISSN-1059-6518 Volume 27 Number 4
The Invader: Wild Parsnip
By Paul MacMillan, AEMT
Illustrations by T.B.R. Walsh
Pastinaca sativa
Danger: Stay away from this invader: wild parsnip in our woods. Wild parsnip juice and ultraviolet light lead to burned skin.
Wild parsnip is also called Pastinaca sativa, its scientific name in Latin. The homeland for this eye-catching, tenacious invasive plant is Europe and Asia. It was introduced into this country as a root crop by European settlers in the 17th century, and it escaped colonial gardens, spreading nearly everywhere. The only states currently free from wild parsnip are Florida, Georgia, Alabama, Mississippi, and Hawaii, according to the U.S. Department of Agriculture.
You may ask what does it look like? It is a member of the carrot family. Wild parsnips are typically biennials, but, on occasion, they can become perennials. The plant will form a rosette of basal leaves for the first year, then flowering the second year. It flowers primarily from May through July.
In its first summer the wild parsnip will have a rosette of leaves close to the ground. The plant is anchored in the soil by a long, thick, edible taproot, much like a carrot. If the growing conditions are right in the second summer, meaning soil impregnated with limestone or lime and in a sunny area, the plant will send up a single flower stalk that will produce hundreds of tiny yellow flowers. They form flat-topped, umbrella-like clusters called umbels. The stalks on the plant can grow up to 4 feet tall or higher. Wild parsnip plants produce a large number of seeds, which contribute to their persistence and spread.
Simple contact with this plant will cause you no harm unless you have supersensitive skin. The danger comes if you damage the plant, and you get the toxic plant juice on your skin. The wild parsnip plant parts contain chemicals called furocoumarins which cause “phytophotodermatitis.” The combination of this plant juice on your skin and some ultraviolet light will produce a burn on your skin.
When your skin comes into contact with these furocoumarins from wild parsnip the chemicals are absorbed into your skin. These chemicals are then stimulated by ultraviolet light, which is present during sunny and cloudy days, causing them to bind with nuclear DNA and cell membranes. This process begins the breakdown of cells and skin tissues. This reaction will take time before the actual skin damage is visible.
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Wild Parsnip
/in Blisters, Burns, Poisons, Rash, Skin, Skin itching/by WMN EditorsISSN-1059-6518 Volume 27 Number 4
The Invader: Wild Parsnip
By Paul MacMillan, AEMT
Illustrations by T.B.R. Walsh
Pastinaca sativa
Danger: Stay away from this invader: wild parsnip in our woods. Wild parsnip juice and ultraviolet light lead to burned skin.
Wild parsnip is also called Pastinaca sativa, its scientific name in Latin. The homeland for this eye-catching, tenacious invasive plant is Europe and Asia. It was introduced into this country as a root crop by European settlers in the 17th century, and it escaped colonial gardens, spreading nearly everywhere. The only states currently free from wild parsnip are Florida, Georgia, Alabama, Mississippi, and Hawaii, according to the U.S. Department of Agriculture.
You may ask what does it look like? It is a member of the carrot family. Wild parsnips are typically biennials, but, on occasion, they can become perennials. The plant will form a rosette of basal leaves for the first year, then flowering the second year. It flowers primarily from May through July.
In its first summer the wild parsnip will have a rosette of leaves close to the ground. The plant is anchored in the soil by a long, thick, edible taproot, much like a carrot. If the growing conditions are right in the second summer, meaning soil impregnated with limestone or lime and in a sunny area, the plant will send up a single flower stalk that will produce hundreds of tiny yellow flowers. They form flat-topped, umbrella-like clusters called umbels. The stalks on the plant can grow up to 4 feet tall or higher. Wild parsnip plants produce a large number of seeds, which contribute to their persistence and spread.
Simple contact with this plant will cause you no harm unless you have supersensitive skin. The danger comes if you damage the plant, and you get the toxic plant juice on your skin. The wild parsnip plant parts contain chemicals called furocoumarins which cause “phytophotodermatitis.” The combination of this plant juice on your skin and some ultraviolet light will produce a burn on your skin.
When your skin comes into contact with these furocoumarins from wild parsnip the chemicals are absorbed into your skin. These chemicals are then stimulated by ultraviolet light, which is present during sunny and cloudy days, causing them to bind with nuclear DNA and cell membranes. This process begins the breakdown of cells and skin tissues. This reaction will take time before the actual skin damage is visible.
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New Hampshire’s New C-Spine Protocol – 2014
/in Back, Back pain, Spine, Teaching Wilderness Medicine, Trauma/by WMN EditorsISSN1059-6518
Volume 27 Number 4
C- Spine Protocol
By Paul MacMillan, AEMT
The State of New Hampshire Bureau of EMS instituted a new Cervical Spine Protocol. We applaud the New Hampshire Medical Control Board for approving this new protocol which represents a significant change in the practice for EMS providers.
For decades the approach to patient immobilization has been accepted and implemented as the standard for care with little scientific evidence justifying this practice. There is also very little data that shows that immobilization in the field has a positive effect on neurological outcomes in patients with blunt or penetrating trauma.
What has been troubling looking at this standard of care is the lack of emphasis on the assessment of the patient before making a decision about immobilization. Historically, emphasis has been on the Mechanism of Injury (MOI) and not on what actually happened to the person. For example we have been trained to look at the damage to the vehicle at a motor vehicle accident or guess how far someone fell and what he or she might have hit on the way down. Because of the severity of the MOI, we would fully immobilize the patient as a precaution.
Because of new technologies and materials were implemented to improve passenger safety in vehicles, vehicle damage may no longer be a strong indicator for spinal injury. Vehicles are now designed to crumple, absorb, and dissipate the kinetic energy produced in a collision and protect the passenger cabin. EMS textbooks advocate backboarding patients that were involved in motor vehicle accidents where there is significant damage to the cars.
In the case of falls, you also need to consider the patient’s overall physical condition. Is the patient a young physically fit, very athletic 20-year-old or an active geriatric patient that has taken this fall? These factors all have to play into a spinal assessment, so it is not just based on the MOI.
With this in mind and all the research that has been done in Europe on the management of possible spinal cord injuries in the pre-hospital setting, in New Hampshire we now have to “rule in a spinal cord injury” versus the “rule out a spinal cord injury” or “when in doubt, board the patient.” We now rely on our patient assessment skills to determine spinal trauma less than the MOI.
We use the same spinal-clearing protocol that we have been teaching in the wilderness setting. According to N.H. Protocols, patients who have experienced a mechanism of spinal injury require spinal motion restriction and protection of the injury site if they exhibit:
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NON-CARDIAC CHEST PAIN
/in cardiac, Chest, Chest Pain, Musculoskeletal, NSAIDs, Shortness of breath/by WMN EditorsISSN-1059-6518
NON-CARDIAC CHEST PAIN
By Frank Hubbell, DO
Illustrations by T.B.R. Walsh
In the June 2014 edition of the WMNL, the pathophysiology, recognition, and treatment of cardiovascular disease was discussed. With these various illnesses the source of the chest pain is a problem with the coronary circulation of the heart itself. In this issue of the WMNL, we will look at the sources of the non-cardiac chest pain.
Imagine you are working with a group of park rangers in the Rockies when the team gets a call for a hiker in distress. As it turns out, the hiker is reportedly on the same trail as you are, and they are an estimated 3 miles away, about a one-hour hike from you present location. According to dispatch, they were notified via cell phone from the hiking party that one of their members is complaining of chest pain and does not feel as if he can continue on.
Dispatch is able to give you some additional information: the hiker is a 46-year-old male, one of four in their hiking group. The group left the trailhead before sunrise and were taking the most direct route to the summit, in hopes that they would reach the summit before sunset and hike down in the dark with headlamps. They are not prepared to stay out overnight. The other three hikers are all men in their late 20’s. They have known each other for years, as he was their outing club director and their math teacher in high school.
An hour later you catch up with the hiking group. They are sitting together under a large pine tree, sharing some gorp (trail mix) and water. You introduce yourself to the patient and explain that you are a paramedic working with the park rangers. The patient is very glad to see you and seems to be quite relieved.
He states that after hiking for several hours, the incline of the trail became quite steep, and he was having a hard time keeping up with his younger companions. As he pushed onward, he began to develop pain in the anterior of his chest, tingling in his hands and arms, shortness of breath, mild nausea, and began to feel weak, almost as if he was going to pass out. He states that he did recover completely after a five-minute rest, but when he would start hiking uphill again, the symptoms returned after about fifteen minutes. Currently, he feels much better, since they have been at rest for the past hour. He feels that he can walk out, as it is mostly downhill.
The real concern regarding this 46yo male, is whether the chest pain is cardiac or not. If cardiac, he deserves rapid evacuation. If non-cardiac chest pain, then he can most likely walk off the mountain.
You should always err on the side of caution and assume that all chest pain is cardiac until proven otherwise. To sort out cardiac chest pain from non-cardiac chest pain requires a good history, specifically looking for the cardiac risk factors and a good physical exam to try to accurately determine the source of the pain. As you read the descriptions of non-cardiac chest pain types, you will notice that some sources would require immediate evacuation. When in doubt, as stated above, always err on the side of caution and assume all chest pain is cardiac until proven otherwise.
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EBOLA VIRUS DISEASE
/in Disease, Ebola, Infection, Uncategorized/by WMN EditorsISSN-1059-6518 Volume 27 Number 3
By Frank Hubbell, DO
What is Ebola Virus Disease?
Ebola virus disease (EVD), also known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans caused by the Ebola Virus.
The mortality rate is about 90%.
The virus is transmitted to people from wild animals by the body fluids and organs of infected animals. This occurs from hunting the animals, butchering them, and consuming them.
In Africa, EVD has been spread by infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines that were either hunted or found dead in the rainforest. It is probable that if the meat had been cooked thoroughly, the virus would have been killed.
Once in the human population, the virus is contagious and can spread via human-to-human transmission through contact with body fluids.
It is stated by the researchers that the Ebola virus cannot be spread airborne, but I humbly disagree. If the virus is in body fluids, when the patient coughs, the virus is going to be expelled and potentially spread by the airborne droplets. The point being, you have to protect your airway as well as using all BSI when working with any patients with a potentially contagious disease.
Currently the EVD outbreaks have occurred in remote villages in Central and West Africa: Sierra Leone, Nigeria, Guinea, and Liberia.
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