Wilderness First Aid Introduction Wilderness First Aid HS 223.
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Transcript of Wilderness First Aid Introduction Wilderness First Aid HS 223.
WildernessFirst Aid
Introduction
WildernessFirst AidHS 223
WildernessFirst Aid
Introduction
Differences between Wilderness and Urban setting:
Definition: Wilderness medicine protocols are in effect when you are more than one hour from definitive medical care.
Time with patient: This can be anywhere from an hour to days at a time
Environment: You may be dealing with extreme environments in addition to the
injured or ill patient.
Improvisation: You may need to create tools for treatment and evacuation from what is available
Communications: May be limited or unavailable
WildernessFirst Aid
Legal Issues
When are you required to render First Aid?
• Job requires it and you are working
• Preexisting Relationship
• Once you start rendering First Aid
Negligence/Good Samaritan Laws:
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.
WildernessFirst Aid
Legal Issues
Consent:There are 2 basic types of consent:•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 backto my ship or Captain Ahab will go fishing without me
WildernessFirst Aid
Legal Issues
General Guidelines:
•Try to know basic medical history of traveling companions
•Make sure patients level of care does not decrease
•Write down everything you do and observe while treating patient (documentation)
•Only do that which you knowI’m sure glad thatWalmart has startedtraining it’s employees in exercise ECG’s
•Periodically take a refresher course in Wilderness First Aid
•Emphasis should always be on PREVENTION
WildernessFirst Aid
General Concepts
Body Systems Approach
Nervous
Circulatory
CRITICALSYSTEMS
Musculoskeletal
Skin
Endocrine
Respiratory
Need to know:
Structure
Function
Problems
WildernessFirst Aid
General Concepts
Circulatory
Structure:
Heart -Pump
Vessels-Arteries, veins, capillaries
Volume- Blood, cells, other fluids
Function:
Maintaining adequate perfusion pressure
Problem:
Shock
Perfusion:
Forcing fluid acrosstissue under pressure
WildernessFirst Aid
General Concepts
Respiratory
Structure:
Neuro drive
Upper Airway -Lips to Larynx
Lower Airway-Larynx to Alveoli
Alveoli
Diaphragm and Chest WallFunction:
O2 in, CO2 out
Problem:Respiratory distress/failure
WildernessFirst Aid
General Concepts
Nervous
Structure:Central Nervous System
•Brain & Spinal Cord
Peripheral Nervous System•Nerves extending from Spinal Cord
Function:System IntegrationVoluntary/Involuntary
Problems:Spinal Cord Injury
(Intra-Cranial Pressure)Increasing ICP
WildernessFirst Aid
Structure:Muscle Types-
Striated (skeletal)Smooth (Blood Vessels)Cardiac
Bone Types-Long bonesJoints
Function:Protection
Problems:
Musculoskeletal
Stable/Unstable injuries
General Concepts
Support
WildernessFirst Aid
General Concepts
Structure:
Function:Problems:
EpidermisDermisAdipose Tissue (FAT)Sweat GlandsBlood VesselsMuscle
ProtectionThermoregulation
Skin
Loss of Integrity
WildernessFirst Aid
Endocrine
Structure:PituitaryParathyroid &Thyroid GlandsThymusAdrenal GlandsPancreasOvariesTestes
Function:Hormone Regulation
Problems:Increased/Decreased Production
General Concepts
WildernessFirst Aid
General Concepts
Compensation Mechanisms• The body continually tries to maintain homeostasis
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 effectCore/Shell effect
ShiveringSweating
Changes in breathing rate
WildernessFirst Aid
General Concepts
Level of ConsciousnessBrain is comparable to an onion in that they
both have layers that can be peeled away (Injured)
=Outer Layers- Higher function (Reasoning skills, Fine motor skills)
Inner Layers- Basic life functions (Lizard Brain) (Breathing, Heartbeat, Compensation mechanisms)
WildernessFirst Aid
General Concepts
Ischemia/NecrosisIschemia…..
Intravascular Extravascular
BleedingMajority of swelling occurs in first 6 hours
Edema (Abnormal Fluid Accumulation)
Can continue to swell for up to 24 hours
Swelling Curve Anything that irritates the body will cause swelling
Hours 1 6 12 18 24
Inadequate Local PerfusionTissue Death
•Embolism•Clot
•Pinched/Crushed
•Swelling•Angulation
Necrosis…....
WildernessFirst Aid
General Concepts
Determining Level of ConsciousnessA - 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)
WildernessFirst Aid
PatientAssessment
Patient Assessment
Why:•Gather Information
•Organize a Response
•Anticipate Problems That May Develop over a Period of Time
•Treat Patient as a Human Being•Learn and use their name•One of the main objectives is to calm the patient down
WildernessFirst Aid
PatientAssessment
Patient Assessment
SceneSurvey
InitialAssessment
Focused History& Physical Exam
WildernessFirst Aid
PatientAssessment
Patient Assessment
SceneSurvey
Safety
Numbers
•SelfUniversal Precautions
•Rescuers•Bystanders•Patients
M.O.I.(Mechanism of Injury)
•Trauma (Tends to happen from Speed)•Medical (Tends to develop over time)•Environmental
• # of Patients• # of Rescuers• # of Resources• Triage (pg. 13)
•Spinal (Is it enough to cause Spinal Injury)
WildernessFirst Aid
PatientAssessment
Patient Assessment
InitialAssessment
• Treat as you Find• 5 Minute Rule What do they have that will kill them in less than 5 minutes
Circulatory
Respiratory Nervous
•Pulse•Severe Bleeding
•Airway•Breathing •Brain/AAAAVPU
•Spine Stabilization
Rules:
• Quick Body Check (If M.O.I. Is due to Trauma)
WildernessFirst Aid
PatientAssessment
Patient Assessment
Focused History& Physical Exam
History
Vital SignsPhysical Exam
SAMPLE
ymptoms
OPQRST
nsetrovocationualityadiateeverityime
llergiesedications
ertinent Historyast Intake/Outputvents preceding Incident
Pulse: Rate, Rhythm, Quality (Adult 60-90)
Respirations: Rate, Sounds, Rhythm (Adult 12-20)
Blood Pressure: Method of MeasurementSkin:Color, Temperature, MoistureAAAAVPUTemperature
(Inspect, Palpate, Auscultate)Head-to-Toe
Deformities, Contusions, Swelling, Tenderness, WoundsChecking for:
Check:Head, Neck, Chest, Abdomen, Pelvis, Extremities, Posterior Body
• Complete and then treat Finish everything before you do anything
Rules:
WildernessFirst Aid Shock
Shock
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
WildernessFirst Aid
Shock
ShockSigns & 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 causesReassure the patient, keep them physically and emotionally calm, maintain AIRWAY
Keep patient warmKeep 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.
WildernessFirst Aid
Shock
ShockASR (Acute Stress Reaction)
Sympathetic ParasympatheticSpeeds up critical systems Slows down 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 periodBlood Pressure will increase in ASR (Sympathetic)
ASR can trigger other medical conditions i.e. Epilepsy, Diabetes, Heart Disease
WildernessFirst Aid
Wounds Bleeding
Wounds/Bleeding
Normal Healing Process
0-24 Hours•Bleeding•Clotting
0-2 Days 2-7 Days 7+ Days•Developing Protective Barrier
•Strong Protective Barrier
•Absorption of Protective Barrier
Barriers to HealingMedical•Diabetes•Smoking•Underlying Medical Conditions
Environmental•Hypothermia•Frostbite•Wet/High Humidity
Mechanism/High Risk Wounds•Crushing Injuries•Open Fractures•Underlying Injuries•Animal Bites•Joint Injuries•Puncture Wounds
Treat AsHigh Risk Wound
WildernessFirst Aid Wounds/Bleeding
Wound TypesOpen - Closed - High Risk
Specific Wound Types
Abrasion
Laceration
Avulsions
Puncture
Amputations
Impaled Objects*
*Impaled Objects can be removed In a Wilderness Setting if: -Safe & Easy to remove -Cannot be Stabilized -Prevents Safe transportation
Wounds Bleeding
WildernessFirst Aid Wounds/Bleeding
Treating Open WoundsWell-Aimed Direct Pressure
Elevation
TourniquetLast resort.. Only if everything else fails
Cleaning a WoundSupplies needed:
•Universal Precautions•Filtered Water•Tweezers•10-15 ml syringe with an 18 gauge catheter
Wounds Bleeding
WildernessFirst Aid
Cold & Hot
Cold EmergenciesFrostbite
Frostbite is local freezing of the tissues of the body. Generally the fingers, toes, cheeks, ears and, nose are most vulnerable.
Types:Superficial:
Partial Thickness: Upper layer tissue damage. Usually no significant tissue loss
Full Thickness:Significant damage to outer layers and can go into muscle and bone.
Definition:
It must be freezing (actual temp.) in order to get frostbite
No permanent damage to the affected tissues
WildernessFirst Aid
Cold & Hot
Cold EmergenciesFrostbite, cont.
Signs/Symptoms:
Superficial: Mild tingling/pain, followed by numbness.Appears whitish/yellowish, waxy looking.Cold and pliable. No damage when thawed.
Partial Thickness: Mild tingling/pain, followed by numbness.Whitish/yellow waxy looking skin. Pliable but “dents”when palpated.Warm, swollen and tender after thawing. Within minutesto hours after thawing blisters will develop. Blisters maybe clear to reddish-blue in color.Area may remain numb after thawing.
Full Thickness: Tissue appears cold, pale and is frozen hard.Described as feeling “wooden”.After warming area becomes deep red, cyanotic or, mottled.Numb, cold and bloodless. Gangrene, mummification develops rapidly
WildernessFirst Aid
Cold & Hot
Cold EmergenciesFrostbite, cont.
Treatment:Superficial/Partial Thickness:
Give Ibuprofen about 1/2 hour before starting, if possible
Warm affected area:Ideally, submerse the affected area in water 1040 to 1080
and leave it in until completely flushed.
Protect from refreezingNever massage/use radiant heat
Full Thickness:
Avoid field rewarming. Allow patient to walk out if prudent.If evacuation delayed consider field rewarmingProtect from refreezing
Administer STRONG pain med’s, if available. (Include ibuprofen to reduce tissue damage)
Evacuate ALL full thickness frostbite
Evacuate if blisters form
WildernessFirst Aid
Cold & Hot
Cold EmergenciesHypothermia
Definition: A lowering of the core temperature of the body to the levelthat brain function is impaired.
Causes of Hypothermia:Acute Exposure: Immersion/Submersion in water.
Occurs in less than One hourBody loses heat 25 times faster in water
Sub-acute Exposure: Occurs in One - Twenty-four Hours
Chronic Exposure: Common in elderly or homeless populations.Occurs in One - Several days
Signs/Symptoms of Hypothermia:
Mild: Loss of fine motor/reasoning skillsShivering“Umbles” Begin
“UMBLES”FumblesMumblesGrumblesStumbles
Moderate: Uncontrollable shiveringWorsening of “Umbles”
WildernessFirst Aid
Cold & Hot
Cold EmergenciesHypothermia, cont.
Signs/Symptoms of Hypothermia:
Severe: Shivering stops, muscles become rigid, unconsciousness, pulse and respirations drop to undetectable levels, high risk of ventricular fibrillation
Treatment of Mild/Moderate Hypothermia:
Change environment, seek shelterRemove wet clothing and replace with dryInsulate patient from cold (Hypothermia Wrap?)
Keep patient moving if ableCreate external heat source: Fire, stove, heat packsGive warm, sweet fluids (No caffeine, alcohol)(Only if they can drink without assistance)Have patient eat if possible
Food Chain for RevivalTo stoke the bodies furnace compare it to starting a fire
KindlingSmall sticks
Logs
Simple sugarsComplex carbs.Proteins/Fats
WildernessFirst Aid
Cold & Hot
Cold EmergenciesHypothermia, cont.
Treatment of Severe Hypothermia:
Treat very gently (Very high risk of myocardial infarction)
Do not try to re-warm, protect from further heat loss
Cut off wet clothing (Even if it’s expensive)Place patient in a Hypothermia Wrap
Add heat (Insulated, warmed rocks, heated water bottles near hands, feet, groin, armpits, neck)
Evacuate as gently and rapidly as possibleCold Weather Guidelines:Know your environment and be preparedPay attention to yourself and your companionsDress to maintain warmth and drynessStay well fed and well hydratedStay dry. Avoid overexertionCarry emergency food and clothes
Avoid tight clothes and bootsDo not sleep with wet, cold feetAvoid alcohol,caffeine, nicotine and other vasoconstrictors
WildernessFirst Aid
Spine Injury
7 Cervical
12 Thoracic
5 Lumbar
Sacrum
Coccyx
Moving A Suspected Spine Injured Patient
Only move if necessary
Stabilize Head and Weight Centers
Person on the head makes the calls
Move in Small IncrementsAxial Movement is Usually BestAlways Maintain HOSAvoid Pushing or Pulling (Try to Lift)
WildernessFirst Aid
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