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Sterling College
Wilderness
Beyond the golden
hour, the golden day.
Delayed notification
time
Delayed response &
evacuation time.
Wilderness
Long-term exposure
and weather concerns.
Dramatic impact on
patient care and on
rescuers.
Wilderness
Rough uneven terrain.
Bad footing.
Wilderness
Equipment
improvisation
Limited equipment and
resources.
Wilderness
Long-term care
Reducing fx and
dislocations
Managing enviro
Survival skills
Map and compass
Weather
Technical skills
Medicolegal Issues
Duty to Act- Due to a prior relationship you
are to provide care.
Standard of Care- Accepted levels of care
expected by training and professional.
Confidentiality- must be established and
maintained.
Consent- informed, implied, minors
Medicolegal Issues
Good Samaritan- protection for voluntary
care given in an emergency.
Right to refuse treatment
Mentally competent, sober, A&O x 3
Understanding of conditions and risks.
Must understand release form and sign.
Medicolegal Issues
Abandonment- terminating care w/o
turning over patient to as or more qualified
provider.
Negligence
Injury occurred
Duty to act
Standard of care violated
Care given caused the injury
Medicolegal Issues
Records- SOAP NOTE
DNR- written documentation giving permission
not to resuscitate.
Advanced Directives- written documentation that
specifies medical treatment should a person
lose consciousness.
Reportable Cases
Animal bites
Suicide or homicide
Crime
Abuse
Definitions
Pathogen: Disease producing organism
Examples: prion,virus, bacteria, protozoa,
intestinal worms
Bloodborne pathogens: pathogenic
mircorganism present in infected blood
that can cause disease in another human
Virus
HAV: hepatitis A virus will make you sick
for a several weeks. 100% recovery
HBV: Hepatitis B virus will make you very
sick 2-3 months, can kill you or leave you
in a permanently weakened state and risk
liver cancer.
HIV: no vaccination available. There are
drugs to keep in check.
No treatment for virus
Body Systems
RID NU CRIME
Respiratory- Oxygen intake and CO2 removal
Immune- Protection, lymphatic
Digestive- Nutrient & Water absorption, excretion
On-going Assessment
SOAP note
Vitals every 5 or 15
Primary Unresponsive Pt
Airway
Breathing
Circulation, pulse, bleeding profusely
Disability, C-spine? Chunk Check
Environment/expose treat for shock,
expose CC
Everyone else, make sure everyone is
cared for no more patients
Primary Responsive
Ask, intro & consent, throughout ask and
tell
Breathing, how well?
Circulation is there life threatening
bleeding> chunk check
Disability MOI for spinal?
Enivironment/expose same
Everyone else
Patient Exam
Rules
One person does the entire exam.
Start at head; then neck-chest-abdo-legsarms-back
Talk with patient
If you elicit pain follow with OPQRST (or PST)
LOOK at site
Avoid unnecessary movement.
Patient Exam
Principles
Inspection- look for bleeding, etc.
Comparison- check symmetry
Palpation- muscles, bones, and joints
Circulation- check all extremities for pulse.
Sensation- check all extremities for sensation.
Motion- check all extremities for motion.
Vitals
Little People Better Stand Proud
LOC
A: alert and oriented X 3
Person
Place
Time
Vitals-Respiratory
Breathing
Asses by: Watching, Feeling, Listening
Rate (30 sec. X 2)
Adults 12-20, Children 18-30, Infants 30-60
Effort
Effortless not shallow/deep
equal chest rise/fall
no use of accessory muscles
Shallow
Slight chest or abdominal wall motion
Labored
increased effort
use of accessory muscles
possible gasping
Nasal flaring
Vitals-Pulse
Pulse- pressure wave that occurs as each
heartbeat causes a surge in the blood circulating
through the arteries
Rate
Adult 60-100, Children 70-120, Newborns 120-160
Strength
Strong: normal strength
Bounding: stronger than normal
Weak or thready: weak and difficult to feel.
Vitals-Skin
Color
cyanosis- bluish
jaundice- yellowish
red
Temperature
hot
warm
cool/cold
Moisture
clammy- slightly moist, not covered in sweat
Dry
Wet
Pupils
PERRL
Pupils
Equal
Round
Reactive to light
Blood Pressure
The pressure of circulating blood against
the walls of the arteries
Systolic: increased pressure with each
contraction
Diastolic: residual pressure during relaxing
phase.
Blood Pressure
Pulse at
wrist = minimum of 90
Enough to perfuse whole body
Femoral = min of 70
Vital organs and brain
Carotid = min of 60
Brain only
Normal Vitals
Respiratory- 12-20 & effort (effortless,
labored, shallow)
Pulse- 50-100 & quality (thready, weak,
strong, pounding)
Skin- Pink, warm, dry
Pupils- PERRL
Blood pressure- 100-140 over 60-90
AMPLE History
*Allergies- type, what causes it, What
happens? how is it normally treated?
Meds- otc, prescription, recreational,
when, what for, how much? How long?
Past pertinent hx, possible preg.?
Last in/out-food, water, urination,
defecation, What, how much? When?
Events- what preceded the incident?
Interviewing
Subjective
What the pt. tells you
What Happened? MOI/HPI
to whom (name, age, sex)
Where
When
CC: OPQRST
In the pts own words. What they told you
Objective
What you see
How was the pt found, what position?
What did physical exam reveal?
Vitals
AMPLE hx
Pertinent negatives
Assessment
What are the possible problems
Number them 1, 2 etc.
Include: possible shock, possible loss of body
temp., dehydration etc.
Plan
What are you going to do
Address each problem, in order.
What changes might you expect over time?
Monitor: redo vitals q 5 or 15 mins.
-Rescue- evac plan
Rescue Survey
How to get help and what to do for others
Re SOAP q 15 min.
Group condition- how well prepared?
Decisions? Evac, send for help? Bivouac?
Sending for help: 2 people, Send SOAP note,
list of group members, how well prepared,
Map with your location and time.
While waiting keep spirits up, fire, stay
available for all, monitor pt and group
Airway Anatomy
Nasopharynx upper through nose
Oropharynx mouth
Pharynx- air (food) passage from nose to larynx
(voice box)
trachea- air only passage (windpipe), front of
neck.
Bronci passage behind sternum- one to each
lung
Bronchioles- more passages in decreasing size
Alveoli- grape like clusters air cells of the lungs
where gas exchange takes place.
Respiratory System
Adjunct Airways
maintain open airway in an unconscious pt
Nasopharyngeal
May be used in responsive pt
Earlobe to corner of mouth =1
Go one size larger if not perfect fit
Oropharyngeal
-Only unresponsive pt, cant have gag reflex
-Earlobe to corner of mouth
-Go one size small if not perfect fit
Trauma
Shock
Hypoperfusion, a pressure problem.
Components of the cardiovascular system
Pump
Pipes
Phluid (Fluid)
Trauma
Shock
Types of shock
Cardiogenic- pump failure, MI, angina
Hypovolemic- low blood volume,
dehydration(sweating, diarrhea, vomiting,
burns), blood loss
Neurogenic-loss of vascular tone- increased
intravascular space cause too much space for
the blood: anaphylaxsis, sepsis, or spinal cord
injury
Trauma
Shock- Vital Signs
Compensatory
LOC: restless,
anxious, disoriented
Skin:
pale/cool/clammy
HR: rapid, weak
RR: rapid, shallow
BP: normal
Pupils: PERRL
Decompensatory
LOC: decreased
Skin:
ashen/cold/clammy
HR: faster, weaker
RR: faster, more
shallow
BP: falling
Pupils: PERRL,
slowing response
Trauma
Shock- SS and TX
SS
Nausea, Vomiting
distant stare off into space
Weakness
Sense impeding doom
TX
Irreversible Shock
Hypoxia to vital organs and waste
products accumulate
Unresponsive
Extremely rapid heart rate
Slow labored breathing
Blood pressure drops, no pulse palpable
Cold blue skin
Trauma
Soft Tissue Injuries
Anatomy of the Skin
Epidermis
Dermis
Subcutaneous Fat
Trauma
Types of Soft Tissue Injuries
Trauma
Soft Tissue Injuries
Principles of Treatment
Maintain BSI
Control bleeding- hemorrhage
Examine wound
Evaluate function (CSM)
Debride
Irrigate
Dress and bandage
Monitor for infection
Trauma
Soft Tissue Injuries
Wound Cleaning Once bleeding has been controlled for 20-30 mins.
Clean around wound with soap and water or PI
Clean the wound by irrigating
Remove foreign objects
Long-term care
Updated on tetanus?
Trauma
Soft Tissue Injuries
Stitches?
Longer than 1/2 inch and scarring is a
concern.
On face, hands, or over a joint.
Injury to a blood vessel, ligament, or tendon.
Trauma
Infections
Local
Swelling
Heat
Aching
Red
Pus
Systemic
Streaking
Swollen lymph nodes
Fever and chills
Septic shock
Tx of Infections
TX
Reclean wound remove any forgein material
Apply local moist heat pack and hot salty water soak (heat slows rate of
reproduction, salt helps draw infected material out). Q 4 hrs for 30 mins.
Oral antibiotic
Open closed wound- to allow pus to drain
Open abscess- incised and drained
Clean area with PI
Numb skin with ice (if possible, not always needed if you have a sharp tool)
Puncture with sharp pierce be sure it is sterile, aviod tendons, ligaments, nerves and
artieries - Compress and drain
Rinse with iodine solution
Cover with sterile dressing continue hot water soaks q4 hr
Evacuate
Is heavily contaminated,
opens a joint space,
involves underlying tendons or ligaments,
was caused by an animal bite,
is on the face, or was caused by a crushing mechanism.
Evacuate:
Any patient with a wound that cannot be closed in the field.
Any patient with an infection that does not improve within 12-24
hours.
Special considerations
Animal bites: very dirty
Leave open to heal after a good scrubbing
Rabies prophylaxis needed?
Tetanus deep dirty puncture wounds every
10 years.
Wet to Dry Dressing: Wet dressing of PI
placed on to wound and allowed to dry over
several hours. Good if difficult to keep wound
clean and dry.
Trauma
Burns
Types of burns
Thermal: external heat source.
Chemical: strong corrosive.
Electrical: electrical current.
Radiation: sun
Trauma
Burns
Principles of burn tx
Remove the patient from immediate dangers.
Stop the burning process. The faster the better w/in 30 sec.
Flush with water for 15-20 minutes.
Remove all clothing and anything that retains heat or could
cut off circulation.
Protect ABCs
Head 9%
Anterior chest/abdo 18%
Posterior chest/abdo 18%
Each arm 9%
Each leg 18%
Genitalia 1%
Burns Evacuation
-10% partial or full thickness burns treat t
life rapid evac
Serious face burns, genitals, armpits,
hands and/or feet Rapid evac
Partial thickness burns <10% should be
evac but not rapid.
Full thickness evac but not rapid
Trauma
Burns
Evacuate Rapidly:
Any patient with signs and symptoms of an airway burn.
Any patient with partial or full thickness burns covering
more than 15% TBSA.
Any patient with partial or full thickness circumferential
burns.
Evacuate
Any patient with a full thickness burn.
Any patient with burns to a special function area: face,
neck, hands, feet, armpits, or groin.
Any patient with a burn that cannot be managed
effectively in the backcountry.
Trauma
Injuries to the Face
General Principles
Suspect spinal injuries.
Maintain airway.
Remove impaled objects from cheeks.
Apply cold compresses to closed injuries.
Trauma
Injuries to face:Eyes
Foreign bodies: flush with sterile saline.
Corneal abrasion: continued foreign body
sensation after rinsing. EVAC.
Impaled objects: Do not remove. Pack around
object and cover with shield. Patch other eye.
Lacerated eyelid: Do not use direct pressure.
Sterile dressing, cover both eyes.
Avulsed/open eye injuries: Cover both eyes, evac
lying down.
You may want to restrain patients arms to prevent from
clutching eyes.
Trauma
Injuries to face: Nose
Epistaxis (nosebleed): Pinch nostrils with
patient sitting up.
Trauma
Injuries to face: Ears
Ruptured eardrum:
Pt will complain of decreased hearing and air rushing
in.
Cover ear with sterile dressing.
Evac
Trauma
Injuries to face: Teeth
Toothaches
Avoid very hot, cold, or spicy foods.
Administer analgesic or topical anesthetic.
Trauma
Injuries to face: Teeth
Removed teeth
Rinse and put back in socket.
Place in patients mouth.
Place in moist gauze.
Trauma
Injuries to face: Teeth
Broken teeth/fillings
Cover with wax, sugarless gum, or temp.
filling.
Trauma
Musculoskeletal
Bones- provide structure, protection, and
motion (also mineral storage and RBC
production.
Muscles- power of movement.
Tendons- attach muscles to bones
Cartilage- cushioning and shock
absorption between bones.
Ligaments- attach bone to bone. Not
meant to stretch.
Trauma
Musculoskeletal Injuries
Fractures- breaks of bones
Dislocations- Pulling apart of a joint that
may injure muscles, tendons, ligaments,
and cartilage.
Sprains- Overstretching of a joint (beyond
normal rom). May injure tendons,
cartilage, ligaments, and muscle.
Strains- Overuse and/or overstretching of
tissue, primarily muscles and tendons.
Trauma
Musculoskeletal- FX
Complete break or crack of a bone.
Trauma
Musculoskeletal- FX
Signs and Symptoms
Pain: particularly Point Tenderness, usually significant
pain.
Swelling/Discoloration
Sound- pt may have heard a snap or pop
Guarding- muscle cramping, tightening?
Deformity- incorrect position or shape?
Reduced ROM- cant move
Reduced CSM- distal to injury
Crepitus- bone on bone
Splinting Principles
Immobilize above and below
avoid the voids
Soft cushioning materials inside, firm
outside
Well padded straps, snug w/bow
Have materials ready before starting
Montior for distal CSMs
Trauma
Musculoskeletal- FX
Improvised splinting
Big
Ugly
Fat
Fluffy
Trauma
Musculoskeletal- FX
Splinting principles
Immobilize entire extremity. Joints above and
below.
Fill all voids with soft, supportive materials.
Soft on the inside, firm rigid outside.
Attach splint with well padded straps tied with
bows.
Prepare splint before moving limb.
Check CSMs distal to injury site.
Trauma
Musculoskeletal- FX
Treatment
Assess (CSM).
If fracture is open, thoroughly irrigate and clean wound
Use gentle traction-in-line (TIL) to establish normal anatomical
position.
Stop if pain increases significantly or you meet resistance.
If the bone ends do not reduce, protect them from freezing or drying.
Dress wounds.
Splint in a position of function
Traction splint mid-shaft femoral fractures.
RICE therapy. Pain medication as needed.
Monitor CSM before and after TIL and splinting.
Monitor wound site for infection and consider antibiotic therapy
for open fractures.
Trauma
Musculoskeletal- FX
Evacuate Rapidly:
Any patient with an open fracture.
Any patient with altered CSM.
Evacuate:
Any patient with an unusable musculoskeletal
injury.
Practice
Teams of 3
Wrist Fx
Ankle Fx
Tib-fib Fx
Scenerio
Improvised traction splinting
Trauma
Musculoskeletal- Joint injuries
Sprains- stretching/tears to ligaments
1st stretch to ligament
2nd partial tear
3rd serious ligament tears
S/S
Pain
Swelling
discoloration
Trauma
Musculoskeletal- Joint injuries
Strains- overstretching of muscle
fibers/tendons
Pull few torn fibers
Tear- many torn fibers
S/S
Bruising
Pain when in use
Trauma
Musculoskeletal- Joint injuries
Treatment
Assess injury for stability and usability.
Assess circulation, sensation and motion (CSM).
RICE Therapy:
4.
5.
6.
7.
Trauma
Musculoskeletal- Dislocations
Assess CSM and injury (LAF)
Attempt to reduce if evac time exceeds one hour or CSM
is compromised
Stop if pain increases significantly or you meet resistance.
Disclaimer
The reduction of dislocations falls outside
the scope of practice for Wilderness First
Responders unless the WFR is acting
under specific protocols established by
and managed by a physician advisor.
Then Why do it?
Reduction immediately after injury, transport and immobilization
easier.
Safety of party.
Less neurological and circulatory risks.
Fx most often improve alignment
Trauma
Musculoskeletal- Evac Guidelines
Evacuate Rapidly:
open fracture.
altered CSM.
unreduced dislocation.
altered CSM after reduction.
Evacuate:
unusable musculoskeletal injury.
first time dislocation, except distal joints of the fingers
or toes.
altered CSM prior to reduction.
unable to use the reduced joint.
persistent pain.
Sprain or FX?
Speech: middle
Vision: back
Hearing: both sides
Creativity, abstract thought, personality: front
Voluntary movement/skilled movement: top
Head Injuries/Anatomy
Brain contained inside hard skull (cranium)
Cerebrum-higher functions
Cerebellum- equilibrium and coordination
Brain stem-vegetative functions: breathing, circulation
Constant ICP
Swelling causes ^ ICP brain squish
LOC decrease with ^ ICP combative, uncooperative,
disoriented
So monitor LOCs
Skull Anatomy
Dura Mater- Leather sac
Arachnoid- Spongy bone tissue full of
cavities,contains CSF
Pia mater- contains blood vessels and
produces CSF
Trauma
Musculoskeletal-Head Injuries
Scalp Damage
Hematoma
Seldom serious
Trauma
Musculoskeletal-Head Injuries
Scalp Damage
Profuse bleeding, seldom serious
Treatment
Direct pressure, bulky dressing
Pull edges of would together
Clean and dress wound
Trauma
Musculoskeletal-Head Injuries
Open Head InjuryBreak in the skull
Reduced LOC
Fx lines
Deformity
Raccoon eyes
Battles sign
Seizures
CSF
Treatment
Stabilize impaled
objects
Cover wound with
bulky sterile dressing
Do not stop blood flow
Trauma
Musculoskeletal-Head Injuries
Closed Head Injury
Brain compressed
Cerebral cortex- behavior
Brainstem- vitals
Trauma
Musculoskeletal-Head Injuries
ICP causes- Changes in LOC
Vitals compensate for pressure
Slowing, bounding HR
Erratic RR, becoming rapid and deep
Widening BP 300/120
Flushed skin, face
Unequal pupils
Headache
Seizures
Impaired vision
Excessive sleepiness
Nausea and vomiting
Ataxia
Trauma
Musculoskeletal-Head Injuries
Trauma
Musculoskeletal-Head Injuries
Evacuate Rapidly:
Patients with increasing disorientation, irritability,
combativeness or otherwise altered LOC.
Patient with persistent vomiting, lethargy, excessive
sleepiness, ataxia, seizures, worsening headache or
vision disturbances.
Any patient with signs of a skull fracture.
Evacuate:
Any patient with a documented loss of consciousness
(V, P, U on the AVPU scale).
Any patient whose signs and symptoms do not show
improvement after 24 hours.
Spinal Injuries
MOIs
Falls high speed, lands on head or
shoulders, spine or 3x height
Car accidents
Head injury- if loss of consc. MOI for spinal
Diving injury
Direct blows
MOI for spinal full spinal immobilization
Spinal Injuries
MOIs
Spinal Injuries
Signs and Symptoms
Difficulty breathing
Locked sensation
Loss of Consciousness
Guarding or Muscle spasms
Altered sensations pins and needles
Weakness or paralysis, numbness
Pain/tenderness along spinal column
Obvious injury
Incontinence
Spinal Injuries
Treatment
Manually stabilize c-spine. Realign (slow & steady)
Check CSMs in extremities
Apply c-collar- still maintain manual immobilization
O2 if available
Move to backboard or litter
Pad and secure to litter
avoid the voids
Reassess csms
Spinal Assessment
Clearing a Spine (focused spinal assessment)
Only after full pt assessment a separate assessment
RUQ
Kidney
Liver
Ascending colon
Small intestine
RLQ
Appendix
Ascending colon
Small intestine
pancreas
Stomach
LUQ
Kidney
Spleen
transverse colon
small intestine
LLQ
descending colon
small intestine
urinary bladder
Trauma
Abdomen
Two categories
Blunt
Penetrating
Trauma
Abdomen
Solid Organs
Kidneys
Liver
Spleen
Pancreas
Damaged by blunt or
penetrating trauma
Blood loss can be life
threatening
Hollow Organs
Gallbladder
Intestines
Stomach
Bladder
More likely damaged by
penetrating trauma
Irritation and infection
Stomach
Digestive System
Digestion
Mashes food
HCL- high acid
Abdominal Trauma
Often in Fetal position
Solid Organs
Massive bleeding
Hollow Organs
Leaking of contents
Infection
Sepsis
Moderate bleeding
Guarding
Obvious external
trauma
Peritonitis with pain
sharp, stabbing or
burning
Treatment
Evisceration
cover with moist sterile dressing
cover that dressing with a dry dressing
long term may need to tease or push them back
Referred pain
Pain may be referred to other areas
Spleen left shoulder
Groin LLQ or RLQ
Liver right shoulder
Cardiothoracic Trauma
Cardiothoracic Trauma
Cardiothoracic Trauma
Pneumothorax
Hemothorax
S/S
Chest pain
Diff breathing, even at rest
Shock
TX
Stabilize fx site
Evac
Cardiothoracic Trauma
Tension
pneumothorax- pt.
unable to breath
S/S
Chest pain
Breathing difficulty
Shock
Distended neck veins
Tracheal deviation
TX
Rapid evacuation
Cardiothoracic Trauma
Sucking Chest Wound
SS
Open would wound
TX
Plug the hole
Occlusive dressing
If tension develops open hole
Cardiothoracic Trauma
Flail Chest
Signs/Symptoms
Chest pain
Difficulty breathing,
even at rest
Paradoxical respiration
Bruising at fx site
Shock
Tx
Tape bulky dressing
over flail
Transport w/ flail down
Cardiothoracic Trauma
Pericardial Tamponade
Leaking of blood or fluids from heart into the
pericardial sac
S/S
Weak pulse
Shortness of breath
Distended neck veins
Medical
Central Nervous System CNS
Brain Anatomy
Brain Anatomy
2% of body wt.
20% of 02
No sensation
Requires constant 02
Medical CNS
Medical
CNS
Unconscious States
AVPU
Medical
CNS- Causes of Unconscious States
Allergies
Epilepsy
Insulin
Overdose
Underdose
Trauma
Infection
Psychological
Stroke
Medical
CNS
Managing a decrease in LOC
Maintain & Monitor breathing
Recovery position (if unconscious)
Rescue breathing
Protect pt
Give sugar
Monitor vitals
Try to discover underlying cause
Evac
Medical
CNS
Seizures
Uncontrolled electrical activity in the brain
resulting in change of LOC or behavior
Generalized: widespread
Rigid (tonic) posture and jerking (clonic)
Head forced to one side or turned backwards
Skin turns pale or cyanotic
Focal motor:
*Tonic-Clonic only involving one body part
*may progress to a generalized seizure
Psychomotor (temporal lobe seizure
*alteration in personality
*possible hallucinations of sight, taste sound
or smell
Medical
CNS
Seizures Tx for Generalized
Protect from harm
Do not put anything in mouth
Place in recovery position
Check for injury
Take a good history
Give O2
For partial, no emergency care is needed just close
monitoring
Do not need to EVAC talk to pt about hx.
Medical
CNS
CVA Signs and Symptoms
Altered mental status
Speech problems
Memory loss
One sided weakness or paralysis
Facial droop/paralysis
Incontinence
Vision changes
Frustration
Medical
CNS
Transient Ischemic Attack
Temporary stroke
Less then 24 hrs.
S/S identical to a CVA
Medical
CNS
CVA Treatment
Reassure
Transport in position of comfort
Be prepared to manage a seizure
Give O2
Evac
Medical
CNS
Cincinnati Pre-hospital Stroke scale
Facial Droop
Normal: Both sides of face move equally
Abnormal: One side of face does not move at all
Arm Drift
Normal: Both arms move equally or not at all
Abnormal: One arm drifts compared to the other
Speech
Normal: Patient uses correct words with no slurring
Abnormal: Slurred or inappropriate words or mute
Have them say you cant teach an old dog new tricks!
EVAC
Evacuate Rapidly:
Any patient with signs and symptoms of a stroke or
TIA.
Any patient with multiple seizures in a short time
period.
Any patient with an altered mental status of unknown
origin.
Evacuate:
Any patient with a first time seizure
Any patient with an isolated seizure of unknown
origin.
Medical- Respiratory
Medical- Respiratory
Medical- Respiratory
Bring in O2 and remove CO2/other gases
Muscles of rib cage and diaphragm pull air
into our lungs.
Automatic, based on CO2 level in the
blood
Medical- Respiratory
Recognizing Inadequate Breathing
Labored breathing- may include use of accessory
muscles (neck muscles, pectorals, and abdo muscles
Retractions- skin around ribs pulling in
Pale, cyanotic or cool skin
Irregular pattern
Decreased or wet lung sounds
Shallow or uneven chest rise and fall
Two words spoken at a time
Medical- Respiratory
Hyperventilation- response to some type
of stress
Hyperventilation Syndrome- rapid
breathing w/o a known cause
Numbness and tingling
Muscle spasms in hands and feet
Chest pain
Treatment
Be suspicious of aspirin poisoning in a child with
Hyperventilation
CALM the Pt.
Treat underlying emotional/anxiety concern
capture the pt.s breathing to slow down,
breath through nose, hold breath 3 sec.
Take a detailed hx
If pt passes out they may stop breathing for up
to 30 sec. If breathing doesnt resume try rescue
breathing
Medical- Respiratory
Pneumonia- Infection in the lungs
S/S
Shortness of breath
Chest pain
Chills
Fever
Sputum production
Productive cough
Medical- Respiratory
Pneumonia
TX
Position of comfort
EVAC
Rest
hydration
Antibiotics
Medical- Respiratory
Asthma- airway swelling, mucus
production, and spasms of lower airway
Extrinsic: reaction to dust, pollen, etc.
Intrinsic: reaction to internal stress (infection,
exercise, etc)
Medical- Respiratory
Medical- Respiratory
S/S
Cough
Dyspnea
Wheezing
Difficulty speaking
shock
Medical- Respiratory
Asthma- Tx
Calming the patient
Change the environment
Assist with inhaler
Epi -- ?
Give copious amounts of water
Prevention: take 2x the amount of medicine
with you in the wilderness 1 for pt one for
leader to hang on to.
Pulmonary Embolism
Medical- Respiratory
Evacuate Rapidly:
Any patient with suspected pulmonary
embolus.
Any patient with a severe or unbreakable
asthma attack.
Evacuate:
Any patient with suspected pneumonia.
Any patient with increased frequency or
duration of asthma attacks or who does not
show improvement with medication.
Treatment
Calm Pt.
Position in maximum effectiveness for
respiration generally sitting up.
Medical
Cardiovascular
Medical
Cardiovascular
Medical
Cardiovascular
Medical
Cardiovascular
Medical
Cardiovascular
Types of cardiac emergencies
Angina Pectoris
Myocardial Infarction
Congestive Heart failure
Medical
Cardiovascular
Angina- interruptions in adequate blood flow
S/S
Chest pain
Shortness of breath
Denial and anxiety
Nausea and vomiting
Light-headedness or dizziness
Rapid, slow, weak and/or irregular heart rate
Pale, cool, sweaty skin
Pain relieved by rest and/or meds.
Medical
Cardiovascular
Myocardial Infarction-blockage/narrowing of the
artery with the result of death to heart muscle
S/S
Medical
Cardiovascular
Medical
Cardiovascular
Medical
Cardiovascular
Medical
Cardiovascular
Angina vs. MI
Chest pain
Shortness of breath
Denial and anxiety
Nausea and vomiting
Light-headedness or
dizziness
Rapid, slow, weak
and/or irregular heart
rate
Pale, cool, sweaty skin
Pain relieved by rest
and/or meds.
Treatment
treat all chest pain as if t were an acute MI
Angina/Myocardial Infarction Treatment
Reassure
Place in position of comfort
Encourage rest
O2 nasal cannula
Aspirin
325 milligrams (one adult dose) if no Hx of allergy
Evacuate
No walking (unless has hx of angina and has rested)
S/S
Anxiety
Rapid pulse
Diff. breathing and/or rapid breathing
Cyanosis
Productive cough
Swollen legs/ankles
Diabetes
Basics
Body runs on sugar (glucose), made from food.
Some body parts store glucose (muscles and liver) as
glycogen, brain can not.
When we eat our blood sugar level rises.
Insulin, a hormone, made by the pancreas is the
key that allows the sugar to be stored or used by our
cells for energy. This lowers the blood glucose levels.
As blood glucose levels decrease insulin levels
decrease.
Basics continue
Glucagon is a hormone that stimulates
the release of stored glucose (glycogen)
from the liver and muscle when blood
sugar levels are low (between meals). (it
raises blood sugar levels).
Medical
Diabetes
Type I (insulin dep.)- insufficient insulin
production
Must inject insulin
Not genetic
1 out every 400 to 600 children.
Type II- partial insulin production or inability to utilize
insulin (cells become insulin resistant).
Can control with diet, exercise, or oral meds.
More common, over 8% of the population
Can be genetic
Associated with obesity
Occurs when
A meal is skipped and insulin is taken
Takes more insulin than normal
Exercises and fails to eat
Vomits after taking insulin
High fever sick using more energy
Medical
Diabetes- Hypoglycemia
S/S
Rapid onset
Diabetes- Hyperglycemia
Occurs when
Insulin is not present
Hyperglycemia
Too little insulin and too much glucose.
Body breaks down fat tissue for energy
producing ketones (acid).
S/S
Slow onset
Hypo/Hyperglycemia
Hypo
Rapid onset
Hyper
Slow onset
Increased hunger,
thirst, urine output,
fatigue
LOC- Restless,
drunken. (late sign)
HR- weak, rapid
RR- increased
Skin- p/w/d
Sweet breath
Hypo/Hyperglycemia- Treatment
Hypo
Give sugar
If unconscious, rub on
gums repeatedly
Give water
Hyper
(insulin (only if pt. can self
administer) You should
never give it.
Tx for shock
Oral fluids)
Evacuate:
Any diabetic patient who is unable to keep his or her
sugar levels under control in a backcountry setting.
Any diabetic patient who experiences:
Medical
Acute Abdomen
Causes of Abdominal Pain
Constipation most common
Bleeding: puncture wound, ectopic preg.
Perforations: Ulcer
Obstructions: Kidney stones, fecal impactions.
Infections: Appendicitis
General Assessment
Observe patients body position
Inspect the abdomen (supine if possible)
palpate
Ask OPQRST
Listen
Ask about nausea and vomiting
Ask about diarrhea and constipation
Ask about blood in urine, stool, or vomit
Check for fever
Monitor for shock
Are there bowel sounds?
Palpate quandrant of complain last
General Treatment
Position of comfort
Rx for shock
NPO
Medical
Acute Abdomen
Appendicitis
Pain in right lower
Quad
Grows worse over 624 hrs.
Rebound pain
Loss of appetite,
Nausea, vomiting, low
fever
Acute Abdomen
Fecal Impaction
Pain in left lower quad
Can build to crampingsevere pain
Hx of constipation
Palpate mass in LLQ or may be distented
Nausea and vomiting
Fecal impaction
Treatment
Hydration huge amounts large glass of
cold water followed by hot drink (coffee or
tea).
Manual disimpaction, well gloved finger.
Medical
Acute Abdomen
Food Poisoning or Guardia?
Often more than one person near the same
time.
Cramps and diarrhea
Nausea, vomiting
Bloody diarrhea EVAC
Fever EVAC
Acute Abdomen
Gallstones
Pain in right upper quad.
Form in gallbladder
Radiating pain (to
shoulder)
Gallstone attacks often
follow fatty meals, and they
may occur during the night.
IF pain does not subside in
a few hours or fever and/or
jaundice develop. EVAC
hydrate. They may want a
pain killer.
women
people over age 60
Native Americans
Mexican Americans
overweight men and women
people who fast or lose a lot of weight quickly
pregnant women, women on hormone therapy, and
women who use birth control pills
Acute Abdomen
Gastroenteritis- inflammation of GI tract
Diffuse pain in lower quads.
Nausea and vomiting
Low fever
Gradual onset
Common due to poor camp hygiene
Transmission
Viral gastroenteritis is highly contagious.
The viruses are often transmitted on
unwashed hands.
People who no longer have symptoms may
still be contagious, since the virus can be
found in the stool for up to 2 weeks after they
recover from their illness.
Treatment
Most cases of viral gastroenteritis resolve
over time without specific treatment.
Antibiotics are not effective against viral
infections.
The primary goal of treatment is to reduce the
symptoms, and prompt treatment may be
needed to prevent dehydration
Kidney Stones
Medical
Acute Abdomen
Signs/Symptoms
Kidney Stones
Sudden sharp,
stabbing pain
Pain in waves
Radiates into lower
abdomen and groin.
Pain may last 24 hours
or more.
Evac if have a fever
Hydrate
Medical
Acute Abdomen
Ulcer- open sore in stomach lining
Pain more severe when eating.
Burning pain
Vomiting coffee grounds
Dark tarry stool
Can get serious if a large amount of blood lost
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Evacuate Rapidly
Any patient with abdominal pain who also has:
Signs and symptoms of shock.
Blood in the vomit, feces or urine.
Pain persisting greater than 12-24 hours, especially constant
pain.
Localized pain especially with guarding, tenderness, distension,
rebound, movement or vibration, or rigidity.
Persistent anorexia, vomiting or diarrhea greater than 24-72
hours.
Fever above 102 F (39 C)
Signs and symptoms of pregnancy (history of sexual activity,
amenorrhea, excessive fatigue, breast tenderness, polyuria and
nausea).
Evacuate
Any patient with abdominal pain that does
not improve with treatment in 12-24 hours.
Any patient with abdominal pain who is
unable to stay hydrated.
Abdominal General Tx
BRAT diet
Consider anti-diarrheals
If the patient is constipated
aggressively hydrate
avoid high fat foods and increase grains, vegetables and fruit
attempt to stimulate bowel movements
Monitor the patient for worsening signs and symptoms
Environmental
Thermoregulation
Heat Production
Basal metabolism: rate at which body
consumes energy to drive reactions which
produce heat
Exercise metabolism: heat produced by
voluntary muscles.
Can produce 15-18 times more heat the basal
metabolism
Heat absorption: sun, fire, other bodies, hot drinks
Environmental
Thermoregulation
Heat loss
Convection: heat lost to the air.
Wind chill factor
Environmental
Hypothermia
Hypothermia- when a body loses heat
faster then it is produced a drop in core
temperature occurs.
Hypothermia is encouraged by
Dehydration
Insufficient caloric intake
Fatigue
Environmental
Hypothermia
Mild Hypothermia: Below 98.6
Environmental
Hypothermia
Moderate Hypothermia: 95
Uncontrollable shivering
Slurred speech
Increased confusion
Increased stumbling
Cold and pale skin
Environmental
Hypothermia
Severe Hypothermia: 90 degrees
Cessation of shivering
Low LOC
Muscle rigidity
Slow and/or non-palpable respirations and
pulse. May appear dead but be alive.
Cold and cyanotic skin
Environmental
Hypothermia
Hypothermia Treatment
Mild/Moderate
Make patient warm and dry
Environmental
Hypothermia
Hypothermia Treatment
Severe
O2 (mouth to mouth in wilderness)
O2 before movement
Environmental
Hypothermia
Prevention
Travel with adequate food, clothing, water.
Stay will fed and hydrated.
Wear layers and adjust prior to sweating.
Pace group to avoid overexertion (sweat,
fatigue, etc.)
Hypothermia Evacuation
Guidelines
Evacuate Rapidly:
Any patient with severe hypothermia.
Environmental
Frostbite
Frostbite- localized tissue damage caused
by freezing.
Predisposing factors
Moisture
Low ambient temps (below freezing)
High winds
Dehydration and poor nutrition.
Environmental
Frostbite
Superficial frostbite: AKA frostnip
White, waxy, numb, cold skin. Still soft and
pliable.
Outer layer of skin may turn red and peel.
Rewarm with warm water or skin to skin
contact. Dont rub!
Administer Ibuprofen.
Environmental
Frostbite
Partial Thickness Frostbite
White, waxy, numb, cold to touch skin.
Harder than frostnip skin, lingering dent.
Blebs will form after rewarming
Clear bleb- superficial damage.
Red bleb- significant damage.
Environmental
Frostbite
Full thickness
Colorless and frozen solid skin. wooden
Feels numb
Keep frozen until you have reached the best
possible situation for rewarming.
Dry and re-insulate
Frostbite Prevention
Environmental
Immersion Foot
Immersion foot: AKA Trench foot
Non freezing injury that causes inadequate circulation
with resulting tissue damage.
32 to 55 degrees
Wet boots, insoles, socks etc.
Damage caused by decreased oxygen to tissue.
Treatment
Rewarm
Warm patient
Keep feet warm, dry, and elevated.
Evacuation Guidelines
Evacuate Rapidly:
Any patient with full thickness frostbite.
Evacuate:
Any patient with more than a few, small, isolated clear
fluid filled blisters formed after warming a local cold
injury.
Any patient unable to use the injured area.
Any patient unable to protect the area from continued
exposure to a cold wet environment or from refreezing.
Any patient whose pain cannot be managed in the
field.
Raynauds Syndrom
Abnormal vasoconstriction of the extremities on
exposure to cold or emotional stress.
-most common in women
-may be result of genetics or prior frostbite
injury
S&Sx: pale, waxy or blueness in fingers or toes.
Numbness and or pins and needles sensations.
RX: Rewarm area (hands on hot drink or belly)
Treat the whole Pt., get them out of wet clothes,
keep them warm and well fed.