Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section III: Critical System Problems and Treatment

Risk Versus Benefit Complete recovery from an episode of hypogly- cemia ends the immediate emergency, but the practitioner must consider the patient’s future safety. Can the patient reasonably expect to pre- vent another episode, and to treat it effectively if it does reoccur? As with other chronic conditions like asthma and angina, definitive treatment is a long way off if the emergency field treatment is not effective. Continued participation in a remote expedition may represent an unacceptable risk to the patient and the rest of the participants. Pre-trip screening can be a useful preventive measure. Diabetics who are poorly controlled in a civilized setting are going to be at considerable risk in the backcountry or offshore. Although well-controlled diabetics will likely fare better in a new situation, lack of experience with the type of trip planned is a red flag for both the patient and the guide. The diabetic patient’s first backcountry experience should probably be less remote with careful consideration given to treatment and evacuation options.