Wilderness Medicine Updates

Patrick Fink, MD
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The podcast for medical providers at the edges, bringing you digestible updates at the growing edge of Wilderness Medicine, Wilderness EMS, Search and Rescue, and more. 

  1. 3/06 ·  Bónus

    Fast Push #4: Expired Resuscitation Medications

    That EpiPen in your kit expired eighteen months ago. Anaphylaxis is happening. Do you use it? This episode digs into a 2025 systematic review from the American Red Cross Scientific Advisory Council that asked a question most of us have quietly wondered about: do expired resuscitation medications still work? We walk through the evidence on the four drugs that matter most in the field — albuterol, aspirin, epinephrine, and naloxone — and what the science actually says when in-date meds aren't an option. In this episode: Why the expiration date is a manufacturer's guarantee, not a tombstone — and what it actually measuresThe honest limitation behind all 17 studies: this is bench chemistry, not human outcomesAlbuterol holding 98% potency 20–30 years out, and why the inhaler's valve is the real weak linkThe aspirin asterisk: solid for years, but down to under 12% active drug at 28–40 yearsEpinephrine that's gone a little brown — discolored doesn't mean toxic, it means weakerThe nornaloxone question, and why decades-old naloxone still isn't dangerousSterility, storage, and the dashboard-baked-pen problem the studies couldn't answerWhere the ethics land: doing something with a probably-weakened drug vs. doing nothingThe takeaway: Carry in-date meds. Rotate your stock. Store them cool and dark. But throw out the binary — in a real emergency with no alternative, that expired pen very likely still has most of its fight left. The mountain doesn't check expiration dates. Neither does anaphylaxis. Reference: Charlton N, Berry DC, Kannan V, Yee R, Carlson JN, Orkin AM. "The use of expired resuscitation medications for life-threatening first aid conditions: a systematic search and narrative review." Resuscitation Plus. 2025;26:101110. Open access (CC BY). As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.

    12 min

  2. 19/05

    Ep. 32 - Airway Fundamentals for Austere Settings

    Prehospital Airway Fundamentals for BLS: Positioning, Pocket Mask, NPA/OPA, BVM, and LMA Dr. Patrick Fink presents a BLS-focused airway fundamentals episode for prehospital and wilderness/SAR responders, emphasizing an ingrained, stepwise approach to stave off respiratory badness.  Links: Airway Fundamentals Video Intersurgical iGel LMA Chapters: 00:00 Airway Basics Overview 01:52 Questions And Upcoming Episodes 04:04 Scenario Mountain Biker 05:33 Airway Positioning Jaw Thrust 09:42 Pocket Mask Ventilations 13:24 Nasal Airway NPA 17:53 Oral Airway OPA 22:22 Putting It All Together 24:26 Oxygen And Bag Valve Mask 29:03 PEEP Valve Tips 30:29 Laryngeal Mask Airway 35:52 Full Airway Algorithm Walkthrough 38:39 What I Carry In My Kit 39:39 Practice And Mental Rehearsal 42:17 Wrap Up And Support The Show As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.

    44 min

  3. 12/03

    Ep. 31: Hypothermia Basics

    In this episode, Dr. Patrick Fink reviews accidental hypothermia for wilderness providers, building on Ep. 27 Thermoregulation, explaining physiologic changes as core temperature falls  and why accurate core temperatures are difficult to obtain in the field.  We learn the modified Swiss staging system (0–4) based on signs and symptoms and outlines field management:  - 0 cold stress (shelter, dry/insulate, warm calories; avoid alcohol),  - 1 mild hypothermia (ataxia/fine motor impairment; passive plus active external rewarming with a hypothermia wrap and heat near axilla/groin; frequent reassessment),  - 2 moderate hypothermia (confusion/lethargy; active external rewarming, evaluate hypoglycemia, gentle handling and no exertion to avoid afterdrop, cardiac monitoring, expedite evacuation),  - 3 severe hypothermia (unresponsive with vital signs; airway/ventilation support, extremely gentle transport) - 4 hypothermic cardiac arrest (60-second pulse check, CPR, limited shocks under 30°C, withhold epinephrine/amiodarone under 30°C, consider intermittent CPR per protocol, and note potassium’s role in termination decisions).  We also briefly contrasts slow non-extracorporeal warming with ECMO/cardiopulmonary bypass, previewing a future episode on advanced care and the HOPE score Links Episode 27: Thermoregulation WMS 2019 Accidental Hypothermia Guideline AHA Hypothermia Guidelines European Resuscitation Council Hypothermia Algorithm Chapters: 00:00 Welcome and Overview 00:48 Hypothermia Basics 01:12 Cooling Physiology 04:06 Severe Effects and Arrhythmias 06:38 Field Temp Challenges 07:41 Swiss Staging Intro 08:35 Stage 0 Cold Stress 11:40 Stage 1 Mild Hypothermia 16:04 Stage 2 Moderate Hypothermia 20:44 Afterdrop and Handling 22:54 Stage 3 Severe Hypothermia 27:00 Stage 4 Cardiac Arrest 27:57 CPR Shocks and Drugs 37:01 Advanced Rewarming ECMO 43:26 Key Takeaways Summary 46:57 Wrap Up and Support As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.

    50 min

  4. 9/02

    Ep. 30 - Rethinking Spinal Immobilization: EMS Evidence Update

    Reevaluating Spinal Motion Restriction: Evidence Update In this episode of Wilderness Medicine Updates, host Dr. Patrick Fink delves into the evolving guidelines and practices concerning spinal motion restriction. Drawing from historical dogma and modern research, Patrick explores the inefficacies and potential harms of traditional spinal immobilization tools like rigid spine boards and cervical collars. Instead, he advocates for more flexible, evidence-based approaches such as using well-padded surfaces and coaching patients to minimize their own motion. Key points from a comprehensive literature review by the National Association of EMS Physicians and other authoritative bodies are discussed, highlighting the shift from immobilization to motion restriction and its practical implications. Listeners are urged to stay updated with current evidence and consult medical directors before altering their practices. Links Ep. 14 - Spinal Immobilization Guidelines Update 2018 ACEP/NAEMSP Sminal Motion Restriction Position Statement Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature Chapters 00:00 Introduction to Wilderness Medicine Updates 00:42 Historical Perspective on Spinal Immobilization 01:44 Transition to Spinal Motion Restriction 03:30 Review of Recent Literature 05:40 Key Findings on Spinal Motion and Neurological Outcomes 09:30 Effectiveness of Backboards and Cervical Collars 12:10 Potential Harms of Immobilization Tools 16:38 Practical Recommendations and Future Directions 21:48 Conclusion and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.

    23 min

  5. 18/01

    Ep. 29 - Wilderness Orthopedics with Dr. Chris Healy

    Wilderness Orthopedics: Managing Trauma in Remote Environments with Dr. Chris Healy In this episode of Wilderness Medicine Updates, host Dr. Patrick Fink tackles orthopedic injuries in the wilderness with Dr. Chris Healy, an orthopedic surgeon and outdoor enthusiast. They explore the management of long bone fractures, traction for femur, pelvic binders, and the nuances of treating injuries in limited-resource environments. The episode covers strategies for handling common injuries like shoulder dislocations, tibia fractures, knee injuries, and how to prioritize care. They also emphasize the importance of timely evacuation and when and how to safely attempt reductions in the field. Links: Donate to the Tina Biddle Memorial Scholarship Sulcus sign / Squaring of the shoulder Chapters: 00:00 Introduction and Episode Overview 01:36 Tribute to Tina Biddle 04:09 Meet Dr. Chris Healy 05:11 Ski Patrol Background and Pre-Hospital Care 08:12 Approaching Orthopedic Injuries in the Field 17:50 Managing Tibia and Fibula Fractures 21:40 Understanding Compartment Syndrome 27:50 Femur Fractures and Traction Splinting 36:57 Pelvic Fractures: Identification and Management 38:41 Understanding Pelvic Fractures and Binders 39:53 The Role of Pelvic Binders in Pre-Hospital Care 41:11 Challenges with Pelvic Binders in the Field 43:15 Proper Placement of Pelvic Binders 46:36 Field Management of Shoulder Dislocations 50:43 Techniques for Reducing Shoulder Dislocations 54:17 Managing Upper Extremity Injuries 57:51 Handling Knee Injuries in the Field 01:00:37 Patella vs. Knee Dislocations 01:08:06 Evacuation Priorities for Knee Dislocations 01:10:53 Common Issues in Pre-Hospital Orthopedic Care 01:15:36 Final Thoughts and Listener Engagement As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.

    1 h 18 min

  6. 14/11/2025

    Ep. 28 - Laura McGladrey, Responder Alliance, and Stress Injury: How to Get Back to Green and Save Living While Saving Lives.

    Understanding Stress Injuries in First Line Responders with Laura McGladrey This episode of Wilderness Medicine Updates, hosted by Patrick Fink, features a conversation with Laura McGladrey, founder of the Responder Alliance. They discuss the critical issue of stress injuries among first line responders, including professional ski patrollers, healthcare workers, and rescue team members. Through personal stories and expert insights, Laura explains the concept of stress injuries, how they develop, and the importance of early detection and mitigation. The episode highlights the need for both individual and organizational strategies to support resilience and manage stress. Listeners are introduced to practical tools, cultural shifts, and personal anecdotes to help maintain a long, healthy, and fulfilling career in high-stress environments. Links Responder Alliance Home Page Access all that the organization has to offer. Responder Alliance: Resource Hub Easy access to critical tools and offerings. The Stress Continuum See the visual continuum that we discuss on the show. Scholarships: Responder Alliance Foundation Apply for aid for an individual or team training. Make a Donation to Responder Alliance Foundation! Join me in making a tax-deductible donation to support the valuable work of the Responder Alliance and bring this work to those who need it, regardless of cost. Chapters 00:00 Introduction and Guest Welcome 02:11 Laura's Background and Work 06:00 Understanding Stress Injuries 10:02 Responder Alliance Mission and Challenges 20:55 Critical Incident Stress Management 30:49 Empowering First Responders 32:13 Daily Investments in Resilience 37:26 Recognizing and Managing Stress 38:14 Organizational Support for Stress Management 39:45 Building Resilient Teams 46:12 Learning from Resilient Leaders 52:42 Resources for Stress Mitigation 57:54 Conclusion and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.

    1 h

  7. 04/11/2025

    Ep. 27 - Thermoregulation: The Physics and Physiology of Body Temperature Regulation

    In this episode of Wilderness Medicine Updates, host Patrick Fink delves into the topic of thermoregulation, explaining how our bodies regulate temperature in response to environmental changes. Listeners will learn about methods of heat exchange (conduction, convection, radiation, and evaporation), how to measure core temperature, and the body's physiological responses—such as shivering, sweating, and blood flow control.  The episode also touches on the effects of age, metabolic stressors, and pregnancy on thermoregulation, as well as the importance of understanding these principles in the context of treating conditions like hypothermia and heat-related illnesses. 00:00 Introduction and Episode Overview 01:29 Importance of Thermoregulation 03:12 Human Thermoregulation Mechanisms 04:20 Measuring Core Temperature 07:55 Heat Exchange Methods 14:52 Behavioral and Physiological Responses 24:48 Sex and Age Differences in Thermoregulation 27:14 Conclusion and Next Steps As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.

    32 min

  8. 10/10/2025

    Fast Push #3: Safeback SBX for Avalanche Asphyxia Prevention

    In this episode of Wilderness Medicine Updates, host Patrick Fink delves into groundbreaking technology designed to improve safety during avalanche events. The focus is on SafeBack SBX, a Norwegian-developed device that supplies air to users buried in avalanches, potentially extending survival time. Patrick reviews new research published in the Journal of the American Medical Association, which demonstrates significant efficacy in delaying hypoxia during simulated avalanche burials. The episode provides an in-depth analysis of SafeBack SBX, its mechanisms, study results, and its comparative and complementary role alongside existing safety technologies like airbags. Concluding with potential applications and limitations, Patrick aids listeners in deciding whether SafeBack SBX is a worthy addition to their avalanche safety gear. Links Eisendle F, Roveri G, Rauch S, et al. Respiratory Gas Shifts to Delay Asphyxiation in Critical Avalanche Burial: A Randomized Clinical Trial. JAMA. Published online October 08, 2025. doi:10.1001/jama.2025.16837 Articles I've written about Safeback: Suffocation or Survival: A Crucial Factor in Avalanche Burials Avalanche Safety: Assessing the Safeback SBX System First Look: Safeback SBX Avalanche Safety System Chapters 00:31 Overview of SafeBack SBX Technology 02:55 Importance of SafeBack in Avalanche Safety 05:40 Details of the SafeBack Study 07:53 Study Results and Analysis 11:07 Implications and Future Directions 15:50 Conclusion and Final Thoughts As always, thanks for listening to Wilderness Medicine Updates, hosted by Patrick Fink MD FAWM. Connect with us by email at wildernessmedicineupdates@gmail.com. You can pay us a compliment and share the show with a new listener on any popular platform here.

    18 min
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Sobre

The podcast for medical providers at the edges, bringing you digestible updates at the growing edge of Wilderness Medicine, Wilderness EMS, Search and Rescue, and more. 

Informação

  • Autoria
    Patrick Fink, MD
  • Anos em atividade
    2023 - 2026
  • Episódios
    37
  • Classificação
    Explícito
  • Copyright
    © 2026 Wilderness Medicine Updates
  • Site do programa
    Wilderness Medicine Updates

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