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Wilderness First Aid Wilderness First Aid HS 223 Midterm test Review Introduction Wilderness First Aid Definition: Wilderness medicine protocols are in effect when you are more than one hour from definitive medical care. Differences between Wilderness and Urban setting: 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 Introduction Wilderness First Aid 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. Legal Issues Wilderness First Aid 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 I must get back to my ship or emergency situation. An unreliable Captain Ahab will go fishing patient is considered to be any patient without me 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 Legal Issues Wilderness First Aid General Guidelines: •Try to know basic medical history of traveling companions •Only do that which you know I’m sure glad that Walmart has started training it’s employees in exercise ECG’s •Make sure patients level of care does not decrease •Write down everything you do and observe while treating patient (documentation) •Periodically take a refresher course in Wilderness First Aid •Emphasis should always be on PREVENTION Legal Issues Wilderness First Aid Blood Pressure 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 Blood Pressure FLOW STOPPED EQUAL FREE FLOW Wilderness First Aid Blood Pressure Estimated Blood Pressure from Pulse Points Can only determine Systolic Number Carotid……….…….50 Brachial……………60 Femoral……………70 Radial………………80 Pedal…………….…90 Blood Pressure Wilderness First Aid Body Systems Approach Circulatory Respiratory CRITICAL SYSTEMS Nervous Musculoskeletal Skin Endocrine General Concepts Need to know: Structure Function Problems Wilderness First Aid Circulatory Structure: Heart -Pump Vessels-Arteries, veins, capillaries Volume- Blood, cells, other fluids Function: Maintaining adequate perfusion pressure Problem: Shock General Concepts Perfusion: Forcing fluid across tissue under pressure Wilderness First Aid Respiratory Structure: Neuro drive Upper Airway -Lips to Larynx Lower Airway- Larynx to Alveoli Alveoli Diaphragm and Chest Wall Function: O2 in, CO2 out Problem: Respiratory distress/failure General Concepts Wilderness First Aid Nervous Structure: Central Nervous System •Brain & Spinal Cord Peripheral Nervous System •Nerves extending from Spinal Cord Function: System Integration Voluntary/Involuntary Problems: Spinal Cord Injury Increasing ICP (Intra-Cranial Pressure) General Concepts Wilderness First Aid Musculoskeletal Structure: Muscle TypesStriated (skeletal) Smooth (Blood Vessels) Cardiac Bone TypesProblems: Long bones Stable/Unstable Joints injuries Function: Protection Support General Concepts Wilderness First Aid Skin Structure: Epidermis Dermis Adipose Tissue (FAT) Sweat Glands Blood Vessels Muscle Function: Protection Thermoregulation General Concepts Problems: Loss of Integrity Wilderness First Aid Endocrine Structure: Pituitary Parathyroid &Thyroid Glands Thymus Adrenal Glands Pancreas Ovaries Testes Function: Hormone Regulation Problems: Increased/Decreased Production General Concepts Wilderness First Aid 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: Shivering Sweating Changes in heart rate Changes in breathing rate Shell/Core effect Core/Shell effect General Concepts Wilderness First Aid Level of Consciousness Brain 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) General Concepts Wilderness First Aid Ischemia/Necrosis Ischemia…..Inadequate Local Perfusion Necrosis…....Tissue Death Intravascular •Embolism •Clot Extravascular •Swelling •Angulation •Pinched/Crushed Swelling Curve Anything that irritates the body will cause swelling Bleeding Majority of swelling occurs in first 6 hours Edema (Abnormal Fluid Accumulation) Can continue to swell for up to 24 hours General Concepts Hours 1 6 12 18 24 Wilderness First Aid Determining Level of Consciousness AAAAVPU- General Concepts Alert and oriented to Person, Place, Time and Events (A+Ox4) Alert and Oriented to Person, Place and Time (A+Ox3) Alert and Oriented to Person and Place (A+Ox2) Alert and Oriented to Person (A+Ox1) Responds to Verbal Stimulus (V) Responds to Painful Stimulus (P) Unresponsive (U) Wilderness First Aid 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 Patient Assessment Wilderness First Aid Patient Assessment Scene Survey Initial Assessment Focused History & Physical Exam Patient Assessment Wilderness First Aid •Self Patient Assessment Safety Universal Precautions •Rescuers •Bystanders •Patients M.O.I. (Mechanism of Injury) Scene Survey •Trauma (Tends to happen from Speed) •Medical (Tends to develop over time) •Environmental •Spinal (Is it enough to cause Spinal Injury) Patient Assessment • # of Patients • # of Rescuers • # of Resources • Triage Numbers Wilderness First Aid Patient Assessment Circulatory Rules: • • • Treat as you Find 5 Minute Rule •Pulse •Severe Bleeding 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 •Breathing •Airway Patient Assessment Nervous •Brain/AAAAVPU •Spine Stabilization Wilderness First Aid Patient Assessment Rules: • Complete and then treat History Finish everything before you do anything Vital Signs O nset P rovocation Q uality R adiate S everity T ime Symptoms A llergies M edications Pertinent History Last Intake/Output Events preceding Incident Focused History & Physical Exam Pulse: Rate, Rhythm, Quality (Adult 60-90) Physical Exam Respirations: Rate, Sounds, Rhythm (Adult 12-20) Head-to-Toe (Inspect, Palpate, Auscultate) Blood Pressure: Method of Measurement Checking for: Skin: Color, Temperature, Moisture Deformities, Contusions, Swelling, Tenderness, Wounds AAAAVPU Temperature Patient Assessment Check: Head, Neck, Chest, Abdomen, Pelvis, Extremities, Posterior Body Wilderness First Aid 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: Shock 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 Wilderness First Aid Shock 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 Wilderness First Aid Shock ASR (Acute Stress Reaction) Sympathetic Speeds up critical systems Parasympathetic 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 period Blood Pressure will increase in ASR (Sympathetic) ASR can trigger other medical conditions i.e. Epilepsy, Diabetes, Heart Disease Shock