Wilderness and Rescue Medicine 8th Edition

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Section III: Critical System Problems and Treatment

Risk Versus Benefit Complete recovery from an episode of hypo- glycemia ends the immediate problem, 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 serious cause for concern 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.