We hope you are enjoying the last bits of fall while winter looms overhead. Check out our case study on dermatitis to finish your autumn off right!

As always, be safe in the outdoors,

While winter nears, most outdoor enthusiasts are squeaking out that last weekend of nice weather before the snow begins to fall. But all over the country, poison ivy, oak, and sumac are also reaching full maturity and a case of dermatitis could put a damper on your final fall weeks. Check out this case study to brush up:

You take a group on a week-long backpacking trip in Colorado backcountry. On the second day, after setting up camp, a couple members of your party leave the trail to spot some promising bouldering areas. That night, one of the climbers, a 25-yr old male, begins to complain of itching and quickly develops a rash with fluid-filled vesicles. He quickly identifies it as poison ivy, saying he's had a similar rash before. How should you treat the following concerns:

1. Only the 25-yr old shows any presentation of poison ivy exposure. Should you worry about the others? If so, how can you minimize their reaction?
2. You have, in your kit, both a topical steroid cream and an oral steroid. Which is more effective?
3. Your patient says that last time he had a very severe rash, but nothing he considers very serious. Do you have to worry about a potential evacuation?

Answers:

1. A first exposure to poison ivy takes much longer to present; the other members, especially those who left the trail, could potentially develop a reaction to the resin, urishiol in poison ivy, though they may not present for up to 21 days. To minimize their reaction, washing with rubbing alcohol is best or cold water with mild hand soap if no alcohol is available.
2. Though topical steroids can sooth itching, mostly before vesicles develop, oral steroids are most effective. The suggested dose for prednisone, an oral steroid, is 60 mg for five days, then 40 mg for five days, then 20 mg for five days. Stopping steroid therapy can cause rebound dermatitis.
3. A second exposure to poison ivy can produce not only a quicker reaction, but also a more severe reaction. Though most cases can be managed in the backcountry, evacuation is essential if the patient develops respiratory or urinary obstruction or if a severe rash develops over a large portion of the body and does not respond to steroid therapy.

Of course, the best treatment is prevention. Help those around you to recognize toxicodendrons like poison ivy pictured above. Also, avoid a reaction by wearing long clothing, staying on trails, and washing thoroughly if you suspect an exposure. Enjoy!

Henry Horton State Park, Lewisburg, Tennessee November 14 - 16, 2008

Zion National Park, Utah - November 19 - 22, 2008

Ouray, Colorado - January 12 - 14, 2008

Rancho Mastatal, Costa Rica - January 19 - 24, 2009

Moab, Utah - May 27 - 30, 2009

The Advanced Wilderness Life Support certification course was originally developed at the University of Utah School of Medicine and has grown significantly since its creation in 1997. The increasing demand for certification resulted in the creation of a new organization, AdventureMed, to promote the responsible growth of the AWLS program. AWLS certification is available to anyone with a medical degree or certification including: MD, DO, RN, DDS, DPM, PA, EMT and Paramedic.

The Wilderness Life Support Institute, a nonprofit organization, was founded by Paul S. Auerbach, MD and Richard Ingebretsen, MD to oversee the content and quality of the AWLS certification program.

The mission of AWLS is to create competence in medical professionals, enabling them to effectively manage emergency medical situations outside traditional medical facilities.