Wilderness First Responder

Sterling College

Wilderness Emergency Care Vs.

Urban Emergency Care
Time & Distance
Urban
Within the golden hour
Rapid notification
Rapid response and
evacuation time.

Wilderness
Beyond the golden
hour, the golden day.
Delayed notification
time
Delayed response &
evacuation time.

Wilderness Emergency Care Vs.

Urban Emergency Care
Environmental
Concerns
Urban
Short term exposure,
weather minimal
concern.
Easy to control, minimal
impact on patient.

Wilderness
Long-term exposure
and weather concerns.
Dramatic impact on
patient care and on
rescuers.

Wilderness Emergency Care Vs.

Urban Emergency Care
Terrain
Urban
Minimal impact, easily
controlled.

Wilderness
Rough uneven terrain.
Bad footing.

Wilderness Emergency Care Vs.

Urban Emergency Care
Equipment and
Resources
Urban
Access to modern
equipment and a
variety of resources.

Wilderness
Equipment
improvisation
Limited equipment and
resources.

Wilderness Emergency Care Vs.

Urban Emergency Care
Specialized
Techniques
Urban
Rare, can call medical
control

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

Modes of Disease Transmission

Direct Contact- direct contact with body
substances (saliva, sputum, blood, urine,
feces, secretions)
Indirect Contact- touching a contaminated
inanimate object
Airborne- infected droplets of saliva or
sputum
Vector- blood sucking insects
Waterborne

Body Substance Isolation BSI

Gloves: always put on!
Handwashing: before and after pt. contact
Masks gowns pocket masks: can use if
you have them
Sharps containers for needles
Wash surfaces, clothing or linen
May have to double bag up and carry out

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

Nervous- Total body control

Urinary-Waste removal

Cardiovascular- Oxygen and nutrient delivery

ReproductiveIntegumentary- Waterproof barrier, thermoregulation
Musculoskeletal- framework, movement
Endocrine- Hormonal metabolism control

Patient Assessment System

Scene Size up
Survey the scene, danger to self and others
BSI
General impression
Consider MOI
Spinal precautions
Determine level of responsiveness
Does patient need to be moved?

Patient Assessment System

Primary survey
Airway
Breathing
Circulation
Disability
Environment/Exposure

Patient Assessment System

Secondary Survey
Patient exam
Vital Signs
History

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 Interviewing Skills

Explore the chief complaint
Onset: When did the pain begin
Palliate/Provoke: What makes it better or
worse?
Quality: What does the pain feel like, in the
patients own words?
Radiate: Does the pain travel?
Severity: 0-10
Time: Is the pain constant or intermittent?

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

V: verbal- responds to verbal stimuli

P: pain- responds to painful stimuli
U: unresponsive to any stimuli

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

Use pt.s name

Dont make promises you cant keep
Dont lie, but be discrete
Make eye contact on their level
Comfort with confidence
Begin broad to specific
Avoid medical jargon

SOAP Notes: Documentation

Helps you remember
Passes information on to others
Support in case of legal issues
Subjective
Objective
Assessment
Plan

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

Cardiovascular Disease terms

Arteriosclerosis: arterial wall lose elasicity
Atherosclerosis: Chol-lipid disposits in arterial linings
Coronary Artery Disease: narrowing of coronary arteries,
prevents blood flow
Angina Pectoris: pain around heart muscle d/t low blood
supply to heart
Myocardial Infarction: Heart attack
Clinical death: no pulse
Biological death: 10 min. after clinicald/t lack of O2 to
brain.
Sudden Cardiac Death: When heart stops beating
unexpectedly no illness or injury

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

Maintain an open Airway, B & C

Treat underlying cause.
Reassure
Keep flat
Maintain body temp.
Hydrate (except abdominal trauma or low LOC)
Monitor vitals.
Evacuate

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

Functions of the Skin

Keep viruses, bacteria, etc. out
Contain water
Thermoregulation

Trauma
Types of Soft Tissue Injuries

Abrasion: scrub easily infected, consider antibiotic ointment

Contusion- bruising, RICE
Laceration: Control bleeding, keep clean
Flap avulsion: control bleeding, clean, replace flap
Puncture: irritate to cause some bleeding to clean wound: infection
Impaled object: Remove if it comes out easily. Head, neck,
chest, abd, or pelvis or difficult to remove, Stabilize it.

Amputation: Control bleeding, clean site. Wrap severed part in

moist sterile dressing and seal in plastic bag evac

Examples of abrasions on the arm and trunk of a victim of a road traffic

accident ...

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

Soft Tissue- Bleeding

Control
Bleeding Control (hemostasis)
Direct pressure (most within 10-20 mins)
Pressure Dressing- if bleeding persists, wrap elastic band for
10 mins. Loosen to ensure distal circulation.

(Digital pressure- digits directly on artery- uncommon)

(Pressure points- where an artery lies close to
bone. No longer also no Elevation)
Internal bleeding?

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

Cover with dry sterile dressing.

Cover dirty wound with dressing soaked in PI (<1%)
Bandage dressing in place.
Change every 12 hrs., sooner if dirty or wet
Check distal CSMs
Monitor for infection

* PI= Providone Iodine

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

Soft Tissue Evac Guidelines

Evacuate Rapidly:
Any patient with an amputation.
Any patient with an object still impaled.
Any patient with a wound that:

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.

Any patient with a wound that shows signs and symptoms of

serious infection.

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

Long term care

Evaluate Severity
Superficial: red, painful, can be itchy.
Partial thickness: Red, painful blisters forming quickly.
Full thickness: can be red, pale or charred. May or may not be
painful

Burns- Long Term Care

Bandage, consider evac, monitor
Dress burn with moist, sterile dressings, then wrap to hold in
place. (NOLSdry and not to use wet very long)
Consider occlusive dressing for large partial or full thickness
burns (NOLS says no occlusive dressing).
Aloe or Silvadene burn cream may be used.
You can cover with burn gel or 2nd skin
Do not pop blisters.
Elevate extremities gently have pt. move area regulary
Consider evac for partial of full thickness burns larger than a
quarter. Consider pain!
Hydrate, keep warm.
Monitor for infection.
If evac is distant re-dress 2x/day- remove old dressing and
reclean.

Burns- Long Term Care

Evaluate for extent
Document
Rule of palms: patients palm = 1% of their total body
surface area.
Rule of Nines

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.

Orbital Fx: Blow-out Fx

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

Blood or CSF draining from ear, indicates a head

injury.
Do not stop flow.
Cover with a dry sterile dressing.

Trauma
Injuries to face: Teeth
Toothaches
Avoid very hot, cold, or spicy foods.
Administer analgesic or topical anesthetic.

Abscessed tooth- infection in root or bone.

Antibiotics

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.

Transverse:broken straight across.

Oblique: broken at an angle.
Comminuted: crushed or in pieces.
Spiral: a twisted crack that spirals around the bone.
Greenstick: a crack that goes partially through the
bone.

Usually impossible to distinguish in the field.

We LAF at a patient whose MOI or CC suggests
fx.

Look Ask Feel - LAF

Look: at site remove clothing (cut only if
neededthey may need it). Compare for
symmetry, bruising, deformity.
Ask: What forces involved? Pain?
Sounds?
Feel: muscle spasms, unstable, crepitis,
point tenderness, CSMs

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.

Can they use the injured site?

When in the wilderness you must weigh
the factors.
people to transport?
Desire of pt to ambulate
terrain
severity of environment
pt desire to continue trip

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.

Rest: Get the pressure off of the injury site.

Ice: Cool the area for 20 minutes.
Compression: Elastic Wrap, distal to proximal.
Elevation: Above the patients heart.

Pain medication as needed.

Allow the injury site to passively warm.
Assess again for usability.
Support the injury with tape or other adjuncts.

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.

In unable to reduce after multiple attempts, splint in the

position found.
After reduction, RICE therapy, pain medication and
immobilization as needed.
Monitor CSM before and after reduction and/or
immobilization.
Passive range of motion (ROM) 2-3 times per day, or to
patient tolerance.

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?

Snap, crackle, Pop (fx)

Normal movement and function (sprain)
Guarding (fx and sprain)
Deformity or angulations (fx)
Discoloration or swelling (sprain)
Point tenderness (fx)
Crepitus (fx)

CNS- Central Nervous System

CNS- Brain and Spinal Cord
PNS- all other nerves
Brain Anatomy
Cerebrum 75% of total brain
Right side- controls right side of head and left body
Left side- left side of head and right body.

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

Fixed volume can not expand

Meniges: pia mater, arachnoid, dura matter
Brain surrounded by CSF between arachoid and pia matter

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

Open Head Injury

Closed Head Injury
ICP

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

Treatment for Serious Head Injuries

If the injury is open, use diffuse pressure with a

bulky dressing to control bleeding.
Manage Airway, Breathing and Circulation.
Administer high-flow/high-concentration oxygen if
available.
Immobilize the spine and elevate the head at
approximately a 30-degree angle. Consider placing
the patient on his or her side to manage the airway.
Evacuate.

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

Flexion- especially when axially loaded

Extension
Compression- landing seated
Distraction- hanging
Rotation- twisting
Lateral bending- hit from side
Penetration
Sudden deceleration
Impact

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

Back boarding principals

A litter can be used
Pad places where pt will feel pressure
Fill spaces (small of back, beneath knees and ankles)
Straps on: upper chest and shoulders, pelvis, upper and
lower legs. FOAM Free of any movement.
Secure head last
Leave arms free
Do not place straps where they interfere with breathing
Pad straps and places between straps
Reassess CSMs
Transport feet first

Spinal Assessment
Clearing a Spine (focused spinal assessment)
Only after full pt assessment a separate assessment

Reliability: A & O x 3 no drugs/alcohol or

temp. issues
No Distracting Pain- treat injury to reduce pain
No signs/symptoms
Range of Motion Test hold head
Rotate
Hyper-extension
flexion

Anatomy or the Abdomen

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

Uterus and Ovaries

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

Spleen- Immune System

Demolishes old red blood cells
Immune support
Wound healing

Liver- Digestive system

Filters blood
Regulates metabolism
Produces bile

Kidneys- Urinary System

Cleans blood

Pancreas- Digestive System

Hormone production * digestive enzymes

Stomach
Digestive System
Digestion
Mashes food
HCL- high acid

Intestines- Digestive System

Small - digestion
Large reabsorbs water

Gallbladder- Digestive System

Collects and stores bile

Abdominal Trauma
Often in Fetal position

Solid Organs

Need good Hx as injury may not be

obvious

Massive bleeding

Rigidity, abd wall

Discoloration
Distention
Pain
Shock
guarding

Hollow Organs
Leaking of contents

Infection
Sepsis
Moderate bleeding
Guarding
Obvious external
trauma
Peritonitis with pain
sharp, stabbing or
burning

Treatment

Ask PQRST questions

Listen for abdominal sounds in all 4 quadrants
RX for Shock
Keep in position of comfort
Wrap abdomen with 6 ACE bandages
Treat wounds as you would any wound
Anticipate nausea and vomiting
Minimize food and water
Monitor vitals
Ask about blood in urine, stool or vomit

Evisceration
cover with moist sterile dressing
cover that dressing with a dry dressing
long term may need to tease or push them back

Injuries to external genitalia

Generally same treatment as wounds
Torsion of the Testis: Sudden onset, red, painful
scrotum
-apply cool compresses, use painkillers,
support testes and evac
- pain will increase w/time
-testis may die in 24 hours w/o surgery
-gentle rotation outward (let them do it)

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

Gender- Specific Emergencies

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

Causes of Unconscious States

Toxins- alcohol
Sugar- not enough or too much
Temperature- high or low
Oxygen- deprivation
Pressure- diving

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

Postictal period: following the seizure as

period of confusion, disorientation,
drowsinwss and fatigue

Partial: Localized part of the brain

Absence:
Patient may stare blindly
Most common in Children
May be assoc. with lip smacking, eye blinking or jerky
movements.

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

 Aura: a warning or an impending seizure

Status epilepticus: More than 30 minutes
of continuous seizure activity or two or
more seizures not separated by a period
of consciousness. EVAC immediately
give O2
a seizure disorder

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.

 Cerebrovascular Accident (CVA) - Stroke

Interruption of blood flow to brain
Hemorrhagic- bleeding in the brain
Ischemic- blood flow cut off -

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!

If anyone of these are abnormal 72% chance it is a stroke

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

Embolism: Obstruction that lodges in an artery. -- lung >pulmonary

Often starts in a deep vein of the leg. High altitude climbers if
dehydrated and tent bound. Oral contraceptives and smoking also
increase risk. 50,000 death/year in US.

Sudden onset of difficulty breathing

Sharp pain and pt is aprehensive
S/S Shock
Similar s/s as spontaneous pneumothorax

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

Sudden crushing 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 not relieved by rest and/or medication

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.

Sudden crushing 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 not relieved by rest
and/or medication

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

Use Nitro- sublingual once q 5 min.

up to 3 and not if systolic is less than 100 as it lowers blood
pressure by dilating the arteries and veins.

Evacuate
No walking (unless has hx of angina and has rested)

Congestive Heat Failure

CHF- collecting of blood/tissue fluids as a
result of heart inadequacy. Rt side = extremity
edema, Lt side = fluid in lungs

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

Insulin Shock: Hypoglycemia

low blood sugar
Hypoglycemia- low blood glucose.
Glucose level depleted
Too much insulin not enough sugar

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

LOC- disoriented- irritable- combative

Rapid HR
RR- normal or shallow
Skin- p/c/c
BP- unchanged or slightly elevated
headache
Extreme hunger pangs

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).

Hyperglycemia, Diabetic Coma

too much sugar in blood, but not enough in cells
(not enough insulin or cells resistant to it)

S/S
Slow onset

Increased thirst, urine output, fatigue

Restless, drunken. (late sign)
HR- weak, rapid
RR- increased
Skin- p/w/d
Sweet breath (ketones)
Dehydrated

Hypo/Hyperglycemia
Hypo
Rapid onset

LOC- disorientedirritable- combative

HR- Rapid
RR- normal or shallow
Skin- p/c/c
BP- unchanged or
slightly elevated
Breath unchanged

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

If not sure give sugar

to a diabetic it
wont cause more
harm to a
hyperglycemic pt.

Hyper
(insulin (only if pt. can self
administer) You should
never give it.
Tx for shock
Oral fluids)

If not sure give sugar

to a diabetic it
wont cause more
harm to a
hyperglycemic pt.

Diabetes Evacuation Guidelines

Evacuate Rapidly:
Any patient who is unconscious due to a diabetic
emergency.

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:

several days of illness,

has vomiting or diarrhea for more than 6 hours,
has moderate to large amounts of ketones in their urine,
cannot moderate their blood sugar readings with additional
insulin
or feels a loss of control of blood sugar levels.

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.

 Who is at risk for gallstones?

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

 What is a kidney stone?

A kidney stone is a hard mass developed from
crystals that separate from the urine.
Normally, urine contains chemicals that
prevent the crystals from forming. If the
crystals remain tiny enough, they will travel
through the urinary tract and pass out of the
body in the urine without being noticed.

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

<>

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

Allow the patient to rest.

Maintain hydration levels

BRAT diet
Consider anti-diarrheals
If the patient is constipated

Small sips of clear liquids

Cold better than hot

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

If evacuation is possible within a few hours, give

nothing by mouth.

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

Radiation: heat given off constantly

Losing heat on a cold night

Evaporation: water to vapor transition requires

energy. Energy = heat
Conduction: warmer object losing heat when
in contacts a colder object.
Body in icy water

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

A case of the umbles.

Loss of fine motor skills
mild stupidity
Lack of sound judgment
Confusion
Apathy
Pale, cool skin
Vasoconstriction: primary defense against heat loss

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

Put patient in dry clothes

Add insulation around patient
Protect from wind/water
If shivering leave alone fastest way to rewarm.
Apply heat to non-shivering patient.
Mild patient may exercise
Feed water and simple carbs.

Environmental
Hypothermia
Hypothermia Treatment
Severe
O2 (mouth to mouth in wilderness)
O2 before movement

Same as mild/moderate but be extra careful

Hypo wrap- patient may survive several days!
Heat packs to soles of feet and palms of hand.
Beware extreme heat

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.

Treat as a frostnip. Prevent refreezing!

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

Wear adequate clothing, stay dry.

Avoid constricting clothing.
Wear mittens.
Avoid cold metal and gasoline.
Stay hydrated.
High calorie diet.
Watch your friends.
Pay attention to fingers, toes, etc.

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.