Wilderness Medicine Updates

Patrick Fink, MD
  • 5.0 (36)
  • Medicine
  • Updated Semimonthly

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. 17h ago

    Ep. 34 - Icy Hot, a case of Heat Illness with Dr. Gavin Clark and Dr. Nick Daniel

    Dr. Patrick Fink interviews Dr. Nick Daniel and Dr. Gavin Clark about an in-hospital case of exertional heat stroke in a mid-20s runner who collapsed just before the finish of an October New England half marathon in 45°F weather. EMS treated presumed SVT with adenosine, but in the ED the patient was hypotensive, profoundly diaphoretic, and altered; an oral temperature was normal while a rectal core temperature was 105.5°F, highlighting that peripheral temps can’t rule out heat stroke.  We discuss rapid “cool first” management using ice packs, misting, and fans to reach 102°F within ~30 minutes, compare cooling methods (cold-water immersion, tarp-assisted oscillation, Quantico method, frozen sheets), review labs showing lactate 9 and AKI, explain sepsis-like physiology via gut hypoperfusion, and note possible risk contribution from recent COVID and acute Lyme IgM positivity.  Links: Ep. 33 - Heat Illness Fundamentals Ep. 27 - Thermoregulation: The Physics and Physiology of Body Temperature Regulation Clark G, Kocen S, Daniel N. Icy Hot: A Case of Unexpected Heat Illness. Wilderness Environ Med. 2026 Jun 16:10806032261458332. doi: 10.1177/10806032261458332. Epub ahead of print. PMID: 42300334. Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness & Environmental Medicine. 2024;35(1_suppl):112S-127S. doi:10.1177/10806032241227924 Chapters: 00:00 Show Intro and Guests 02:43 Meet the Doctors 03:48 Race Day Collapse Setup 04:47 Finish Line Differential 06:48 EMS Report and History 08:55 Core Temp Surprise 11:25 Field Temp Takeaways 13:38 Rapid Cooling in ED 15:36 Cooling Rates and Goals 16:28 Immersion and Alternatives 18:17 Tarp and Body Bag Hacks 19:32 Quantico and Frozen Sheets 21:10 Field Cooling Methods 21:48 Lab Workup Red Flags 23:23 Lactate Nine Explained 24:21 Heatstroke Sepsis Pathway 26:40 Hidden Factors COVID Ticks 29:09 Fever Versus Hyperthermia 31:27 Prehospital Takeaways 35:00 Race Day Kit Checklist 36:35 Cool First Transport Later 37:29 Outcome And Wrap Up 39:46 Podcast Closing Notes 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.

  2. Aug 25 ·  Bonus

    Fast Push #5 - TCCC Tourniquet Update

    Forty to seventy-five percent of tourniquets placed in the field are never actually needed. In Ukraine, tourniquets left on too long during delayed evacuations have cost people limbs that the original wound never would have. This fast push covers the new May 2026 TCCC Guidelines update and two CoTCCC training briefs on tourniquets, built around lessons from prolonged evacuations in the Russo-Ukrainian war. Topics: telling truly life-threatening bleeding from bleeding that just looks bad, the case of an 11.5-hour tourniquet that cost an arm, reassessment moving from a medic-only skill to something every responder needs, the six options at reassessment (remove, convert, reposition, tighten, add a second, leave alone), how to convert a tourniquet, and what changes once one's been on past six hours. Takeaway: applying a tourniquet is the easy part. Knowing what to do with it for the next several hours is what actually saves the limb. References: Committee on Tactical Combat Casualty Care. TCCC Guidelines, 01 May 2026. https://deployedmedicine.com/tccc Full guidelines PDF: https://learning-media.allogy.com/api/v1/pdf/18ccfdfc-a076-47e9-8a34-376efdd81b43/contents Butler F, Holcomb J, Dorlac W. TCCC Quick-Look: What Kind of Bleeding Requires a Tourniquet? 19 May 2026. https://www.aast.org/static/dadfd895-d295-4a5d-9f45f8d92940991c/TCCC-260521-TCCC-Quick-Look-Who-Needs-a-Tourniquet.pdf Koch EJ, Andersen M, Barbee GA, et al. Standardizing Tourniquet Reassessment and Conversion Across TCCC Tiers: TCCC Guidelines Proposed Change 25-2. J Spec Oper Med. 2026;26(1):M4V1-O3Y7. This is the peer-reviewed paper behind the Tourniquet Reassessment Quick-Look. https://jsomonline.org/product/standardizing-tourniquet-reassessment-and-conversion-across-tccc-tiers-tccc-guidelines-proposed-change-25-2/ PubMed: https://pubmed.ncbi.nlm.nih.gov/41818038/ 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.

  3. Jul 30

    Ep. 33 - Heat Illness Fundamentals: Recognize the Spectrum, Cool First, Transport Second

    Dr. Patrick Fink reviews the spectrum of heat illness using 2024 Wilderness Medical Society guidelines, covering recognition, physiology, field treatment, and key mimics. He distinguishes heat edema, heat cramps (salt-depletion vs exercise-associated), heat syncope and exercise-associated collapse, and defines heat exhaustion by preserved mental status versus heat stroke by altered mental status in a heat context, warning not to wait for a temperature threshold. He explains heat stroke pathophysiology as direct thermal injury plus a sepsis-like inflammatory cascade from gut hypoperfusion and barrier failure, emphasizing “heat × time” and a 30-minute cooling window. Core management is “cool first, transport second,” with cold water immersion as gold standard and improvised “tarp taco” alternatives; stop cooling around 38.3–38.8°C, avoid antipyretics and dantrolene, and use fluids only as support. He highlights exercise-associated hyponatremia as a dangerous mimic requiring hypertonic saline, and discusses disposition, including possible field release after full recovery within two hours for healthy exertional cases. Links Episode 27: Thermoregulation: The Physics and Physiology of Body Temperature Regulation Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update Chapters 00:00 Heatstroke Trail Scenario 01:02 Episode Roadmap 03:34 Thermoregulation Basics 06:43 Mild Heat Illness 11:21 Heat Exhaustion Line 13:32 Heat Stroke Recognition 17:18 Why Heatstroke Kills 22:37 Cool First Transport Second 24:51 Cold Water Immersion 27:31 Improvised Field Cooling 28:28 Myths Meds and Fluids 33:56 Hyponatremia Mimic 36:57 Disposition and Transport 39:38 Gear and Preparation 41:05 Key Takeaways Wrap Up 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.

  4. Jun 3 ·  Bonus

    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.

  5. May 19

    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.

  6. Mar 12

    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.

  7. Feb 9

    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.

  8. Jan 18

    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.

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5
out of 5
36 Ratings

About

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. 

Information

  • Creator
    Patrick Fink, MD
  • Years Active
    2023 - 2026
  • Episodes
    40
  • Rating
    Explicit
  • Copyright
    © 2026 Wilderness Medicine Updates
  • Show Website
    Wilderness Medicine Updates

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