Wilderness

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Wilderness First Aid
Midterm test Review
Introduction
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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
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Wilderness First Aid
When are you required to render First Aid?
Negligence/Good Samaritan Laws
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Wilderness First Aid
Consent
There are 2 basic types of consent
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General Guidelines

• Try to know basic medical history of traveling
  companions

• Make sure patients level of care does not decrease

• Emphasis should always be on PREVENTION

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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
FREE FLOW
Blood Pressure
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Blood Pressure
Estimated Blood Pressure from Pulse Points
Can only determine Systolic Number
Carotid..50
Brachial60
Femoral70
Radial80
Pedal.90
Blood Pressure
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Wilderness First Aid
Body Systems Approach
Need to know
Structure
Function
Problems
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Wilderness First Aid
Circulatory
Structure
Volume- Blood, cells, other fluids
Function
Maintaining adequate perfusion pressure
Problem
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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
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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)
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Wilderness First Aid
Structure
Muscle Types-
Striated (skeletal)
Smooth (Blood Vessels)
Cardiac
Bone Types-
Problems
Long bones
Joints
Function
Protection
Support
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Structure
Epidermis
Dermis
Adipose Tissue (FAT)
Sweat Glands
Blood Vessels
Muscle
Problems
Function
Protection
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Function
Problems
Increased/Decreased Production
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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
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Level of Consciousness
Outer Layers- Higher function (Reasoning skills,
Fine motor skills)
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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
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Determining Level of Consciousness
A - Alert and oriented to Person, Place, Time
and Events (AOx4)
A - Alert and Oriented to Person, Place and
Time (AOx3)
A - Alert and Oriented to Person and Place
(AOx2)
A - Alert and Oriented to Person (AOx1)
V - Responds to Verbal Stimulus (V)
P - Responds to Painful Stimulus (P)
U - Unresponsive (U)
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Patient Assessment
Why

• Learn and use their name

• One of the main objectives is to calm the patient
  down

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Patient Assessment
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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)

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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

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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
Physical Exam
Pulse
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
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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
Shock
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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
Dont 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
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Shock
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