Wilderness First Aid

1. Wilderness First Aid HS 223 Wilderness First Aid Midterm test Review Introduction

2. Definition: Wilderness medicine protocols are in effect when you are more than one hour from definitive medical care. Environment: You may be dealing with extreme environments in addition to the injured or ill patient. Communications: May be limited or unavailable Wilderness First Aid Differences between Wilderness and Urban setting: Time with patient: This can be anywhere from an hour to days at a time Improvisation: You may need to create tools for treatment and evacuation from what is available Introduction

3. Job requires it and you are working • Preexisting Relationship • Once you start rendering First Aid Good Samaritan laws are designed to protect individuals that render first aid. They will be in effect as long as the first aider does what a normal, reasonable person with the same level of training would do. Legal Issues Wilderness First Aid When are you required to render First Aid? Negligence/Good Samaritan Laws:

4. Informed Consent: When a reliable patient gives consent • to treatment after being informed of • the risks and benefits • Implied Consent: A legal assumption that an unreliable • patient would want help during an • emergency situation. An unreliable • patient is considered to be any patient • who is not fully alert and oriented as to • who or where they are. Implied consent • also applies to minors(under18) whose • parents are not available to give consent I must get back to my ship or Captain Ahab will go fishing without me Legal Issues Wilderness First Aid Consent: There are 2 basic types of consent:

5. Wilderness First Aid I’m sure glad that Walmart has started training it’s employees in exercise ECG’s • Only do that which you know • Write down everything you do and • observe while treating patient (documentation) • Periodically take a refresher course in Wilderness First Aid Legal Issues GeneralGuidelines: • Try to know basic medical history of traveling companions • Make sure patients level of care does not decrease • Emphasis should always be on PREVENTION

6. Blood Pressure Wilderness First Aid FLOW STOPPED EQUAL Normal Adult Blood Pressure 120/80 Systolic:The pressure of the blood against the artery walls when the heart is contracted Diastolic: The pressure of the blood against the artery walls when the heart is relaxed SYSTOLIC DIASTOLIC SOUND FREE FLOW FREE FLOW Blood Pressure

7. Blood Pressure Wilderness First Aid Estimated Blood Pressure from Pulse Points Can only determine Systolic Number Carotid……….…….50 Brachial……………60 Femoral……………70 Radial………………80 Pedal…………….…90 Blood Pressure

8. Circulatory CRITICAL SYSTEMS Respiratory Nervous Musculoskeletal Skin Endocrine General Concepts Wilderness First Aid Body Systems Approach Need to know: Structure Function Problems

9. Heart -Pump Vessels-Arteries, veins, capillaries Perfusion: Forcing fluid across tissue under pressure Shock General Concepts Wilderness First Aid Circulatory Structure: Volume- Blood, cells, other fluids Function: Maintaining adequate perfusion pressure Problem:

10. Respiratory Neuro drive Respiratory distress/failure General Concepts Wilderness First Aid Structure: Upper Airway -Lips to Larynx Lower Airway- Larynx to Alveoli Alveoli Diaphragm and Chest Wall Function: O2 in, CO2 out Problem:

11. Nervous Increasing ICP General Concepts Wilderness First Aid Structure: Central Nervous System • Brain & Spinal Cord Peripheral Nervous System • Nerves extending from Spinal Cord Function: System Integration Voluntary/Involuntary Problems: Spinal Cord Injury (Intra-Cranial Pressure)

12. Musculoskeletal Stable/Unstable injuries General Concepts Wilderness First Aid Structure: Muscle Types- Striated (skeletal) Smooth (Blood Vessels) Cardiac Bone Types- Problems: Long bones Joints Function: Protection Support

13. Wilderness First Aid Skin Loss of Integrity Thermoregulation General Concepts Structure: Epidermis Dermis Adipose Tissue (FAT) Sweat Glands Blood Vessels Muscle Problems: Function: Protection

14. Wilderness First Aid Endocrine Structure: Pituitary Parathyroid &Thyroid Glands Thymus Adrenal Glands Pancreas Ovaries Testes Hormone Regulation General Concepts Function: Problems: Increased/Decreased Production

15. Wilderness First Aid • The body continually tries to maintain homeostasis Shivering Sweating Changes in breathing rate General Concepts Compensation Mechanisms Homeostasis- Relative constancy in the internal environment of the body… • In a wilderness context you must weigh the short term gains versus the long term damage or consequences Examples of ways the body compensates: Changes in heart rate Shell/Core effect Core/Shell effect

16. Wilderness First Aid Brain is comparable to an onion in that they both have layers that can be peeled away (Injured) = Inner Layers- Basic life functions (Lizard Brain) (Breathing, Heartbeat, Compensation mechanisms) General Concepts Level of Consciousness Outer Layers- Higher function (Reasoning skills, Fine motor skills)

17. Wilderness First Aid Swelling Curve Anything that irritates the body will cause swelling Hours 1 6 12 18 24 General Concepts Ischemia/Necrosis Ischemia….. Inadequate Local Perfusion Necrosis….... Tissue Death Intravascular • Extravascular • Swelling • Embolism • Angulation • Clot • Pinched/Crushed Bleeding Majority of swelling occurs in first 6 hours Edema (Abnormal Fluid Accumulation) Can continue to swell for up to 24 hours

18. Wilderness First Aid General Concepts Determining Level of Consciousness A - Alert and oriented to Person, Place, Time and Events (A+Ox4) A - Alert and Oriented to Person, Place and Time (A+Ox3) A - Alert and Oriented to Person and Place (A+Ox2) A - Alert and Oriented to Person (A+Ox1) V - Responds to Verbal Stimulus (V) P -Responds to Painful Stimulus (P) U - Unresponsive (U)

19. Patient Assessment Wilderness First Aid • Gather Information • Organize a Response • Anticipate Problems That May Develop over a Period of Time • Treat Patient as a Human Being Patient Assessment Why: • Learn and use their name • One of the main objectives is to calm the patient down

20. Patient Assessment Wilderness First Aid Scene Survey Initial Assessment Focused History & Physical Exam Patient Assessment

21. Patient Assessment Wilderness First Aid M.O.I. (Mechanism of Injury) Patient Assessment Safety • Self Universal Precautions • Rescuers • Bystanders • # of Patients • Patients • # of Rescuers Scene Survey • # of Resources • Triage Numbers • Trauma (Tends to happen from Speed) • Medical (Tends to develop over time) • Environmental • Spinal (Is it enough to cause Spinal Injury)

22. Patient Assessment Wilderness First Aid Patient Assessment Circulatory Rules: • Pulse • Treat as you Find • Severe Bleeding • 5 Minute Rule • What do they have that will • kill them in less than 5 minutes • Quick Body Check • (If M.O.I. Is due to Trauma) Initial Assessment Respiratory Nervous • Breathing • Brain/AAAAVPU • Airway • Spine Stabilization

23. Patient Assessment Wilderness First Aid Focused History & Physical Exam Patient Assessment nset OPQRST rovocation uality Rules: SAMPLE ymptoms adiate History llergies • Complete and then treat Finish everything before you do anything everity edications ime ertinent History ast Intake/Output vents preceding Incident Vital Signs Pulse: Physical Exam Rate, Rhythm, Quality (Adult 60-90) Respirations: Rate, Sounds, Rhythm (Adult 12-20) Head-to-Toe Blood Pressure: Method of Measurement (Inspect, Palpate, Auscultate) Checking for: Skin: Color, Temperature, Moisture Deformities, Contusions, Swelling, Tenderness, Wounds AAAAVPU Check: Temperature Head, Neck, Chest, Abdomen, Pelvis, Extremities, Posterior Body

24. Shock Wilderness First Aid Shock occurs when the tissues or organs of the body are inadequately supplied with oxygenated blood. Types of Shock: Hypovolemic: Loss of fluid from bleeding, sweating, vomiting, diarrhea and/or severe burns. Cardiogenic: Failure of the heart to adequately pump blood. Vasogenic: Loss of vascular tone resulting in an increased vascular space. ( Spinal Cord Injury, Sepsis, Anaphylaxis) Stages of Shock: Compensatory: Peripheral vasoconstriction, increased HR and increased respiratory rate to keep blood pressure within normal limits to maintain adequate perfusion pressure. Decompensatory: Blood pressure starts to drop and inadequate perfusion begins Irreversible: Organs begin to die from inadequate perfusion Shock

25. Shock Wilderness First Aid Signs & Symptoms: Early: LOC: Anxious, restless, disoriented HR: Rapid, weak and, thready RR: Rapid and shallow SCTM: Pale, Cool and clammy (may be pink and warm with vasogenic shock) Symptoms: Patient may feel nauseated and may vomit, and may complain of dizziness and/or thirst. Late: BP: Falls, Radial pulse weakens and eventually disappears Pupils: Progressively slower to respond Treatment: Don’t wait for shock. Treat before serious signs develop Look for and treat underlying causes Reassure the patient, keep them physically and emotionally calm, maintain AIRWAY Keep patient warm Keep the patient flat with legs elevated no more than 12 inches when appropriate Administer fluids orally if care is extended and the patient can tolerate them. Monitor the patient closely for deteriorating vital signs. Shock

26. Shock Wilderness First Aid ASR (Acute Stress Reaction) Parasympathetic Sympathetic Slows down critical systems Speeds up critical systems Temporary vascular dilation Patient will usually faint Problems: ASR mimics true shock Pain masking ASR is a temporary condition controlled by the Autogenic nervous system Differences between True Shock and ASR: ASR goes away after a short period Blood Pressure will increase in ASR (Sympathetic) ASR can trigger other medical conditions i.e. Epilepsy, Diabetes, Heart Disease Shock