Utah ski trip

View from Alta

Despite all the fun trips I get to go on for work i still take some of my own.

My brother and I planned a ski trip to Utah a couple of months ago. The plan was to fly out early Thursday morning - take advantage of the quick start ski pass - which gives you free skiing on your day of arrival - and then ski Friday, Saturday and Sunday. We stayed with Adam and his roommates down in Salt Lake City.

Riding the lift at Alta

Of course great plans never go as planned. On our way out an ice storm hit salt lake and our flight was diverted to Denver where we waited for several hours. Eventually we made it to salt lake around 5 or 6ish. Managed to rent a ford focus and head to Adam's. We contemplated night skiing but were both exhausted after our 445 am est wake up. We went to the red iguana - an awesome Mexican place and called it a night.

Friday Stephen and I drove up to alta. We skied there all day with a brief stop for some lunch. It was great. No crazy powder but nice snow ( especially for nc natives). Friday night we hit up a local Thai place and crashed early.

Adam in the backcountry

Saturday Adam was off and the avalanche forecast looked promising ( for no avalanches) so we headed to Mill D in big cotton wood canyon. We skinned up a summer road past multiple cabins and eventually entered the groves of tree and made our way up to an open peak. It took about 3 hours to make it up. We saw several other groups out as well. We dug a snow pit and used compasses and a cline meter to determine the best way down. It had just started snowing as we headed down.

Going down we cut through fresh powder with a few tracks and then cut through the groves of aspen trees. It was awesome!!

Fried Twinkies

We sorta skipped lunch - so hit the bayou for dinner and beers. Plus fried twinkles for dessert :)

Today ( Sunday) we hit snowbird for a couple hours of skiing prior to flying home. For the first time you could see blue sky when we left salt lake. By the time we made it to snowbird the snow was beginning to fall. It became heavier as the day progressed. To the point all the ski tracks were covered up by the time you rode the lift to the top. It was a bit windy too.
We made it back down to salt lake as planned to catch the plane. The trip to the airport was a little sketchy as the roads were completely covered in snow. I drove pretty slowly as the ford focus isn't a great snow vehicle. We made it through security and grabbed a bite to eat prior to heading to the gate. The snow continued to come down and our plane was diverted elsewhere. Not a good travel trip for e. after over a 4 hour delay we are headed home with a 3 am arrival time. Ugh!

The trip was well worth it. Two great days of resort skiing and a day in the backcountry!

Medical Student Elective

One of the cool parts of my job is getting to help with the 1st year medical student elective in wilderness medcine. Today I did lectures on ortho injuries and splinting and also on airways with a emphasis on crics. The students then got to rotate through stations to practice intubation, crics and splinting techniques.

Its always rewarding to realize how much you've learned when teaching medical students and see how enthusiastic they are to learn new practical stuff.

Ethics and DNR

Emergency medicine can be a tough field. We don't have pre-existing relationships with most of our patients, nor do we have time to discuss the intricacies of their wishes when things are going poorly. Last night with very little warning a patient rolled in from a nursing home who was profoundly bradycardic (HR 7 - 10) with a BP in the 50s.  Due to inadequate respirations the patient had a combitube (which is a supraglottic airway) placed by EMS through which the patient was receiving assisted respiration  This paperwork accompanied the patient. What would you do?  

This case demonstrates to me the need for physicians and families to have candid discussions with each other regarding end of life care. To me it seems medically futile to perform chest compressions without giving drugs and without establishing an airway. I think part of our duty as physicians and healthcare providers is to have these difficult conversations and help guide people to make the right (and medically appropriate) decisions for their loved ones. 

Wilderness First Aid Course

One of the cool things about my job is getting to teach wilderness medicine to lots of different skill levels. Admittedly I have a lot more experience teaching medical students and residents and other healthcare professionals. Sometimes its tricky to flip out of "healthcare" language and teach others in plain english. 

Mike and I had fun teaching a Red Cross Wilderness First Aid course to a group of boy scouts and scout leaders on Jan 11-13.  We taught CPR on Friday night and then a two day WM course out a Daniel Marshall Camp - which is a camp located out on Strom Thurmond lake just west of Augusta. 

I did several lectures and led some hands on scenarios. We covered numerous topics from primary and secondary survey to wound care and splinting.

Airplane wilderness

I've always wondered if I'd ever be on a plane when there was a need for medical personnel. Guessing it is sort of fitting that the first flight I take with my new "silver medallion" status some medical skills are needed.

An older gentleman (80s) slowly made his way down the aisle in front of me after getting out of a wheelchair on the jetway. While the flight attendant assisted him in taking off his jacket it became apparent his upper left arm was bleeding. Nothing scary - just oozing from his dialysis site and from what he described as a skin year. I guess I was looking a little too intently as the flight attendant ask me, "you aren't a nurse by any chance are you?" I replied "no, I'm actually a doctor". She asked if I could help. I agreed. She asked what I needed and I asked for some gauze and tape.

I don't think they wanted to breakout the real kit so I was presented with a couple paper towels, several band aids, an alcohol pad and some gloves. No gauze or tape on this flight - however eventually was given a roll of masking tape.

Improvising with the super absorbent and masking tape plus some patient applied pressure the bleeding stopped.

Another life saved:) planes are a lot like the wilderness...

Florida bound

Today I'm heading down to Bonita springs for the wilderness EMS director course! I've spent the past week working on lectures for the WMS student elective, irb proposals and various research stuff.

Over New Years several friends and I rented a cabin in Boone. It was an awesome time - got to Mtn bike at Ricky knob twice and ski at sugar mountain. Plus hang out in the hot tub and test some fireball whiskey.... Which is surprisingly tasty.