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 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
Dr. John Doe 215-555-7777 Dr, Bill Doe 215-555-6666 Doctors Card printed 7/1/2011 Bob Smith Brother H-215-555-4444 C-215-555-5555 Jane Smith wife H-215-555-1111 C-215-555-3333 Penicillin Mushrooms Peanuts Emergency Contact Numbers Allergies Any Insurance Company Policy# 1234567890 Nitroglycerin 10mg 4/day Lipitor 25 mg 4/day H- 215-555-1111 C- 215-555-2222 Medications Anytown, Pa. 19111 111 Anystreet Rd Angina, Coronary Artery Disease ,High Cholesterol, Asthma John Smith D.O.B 01/01/1951 Conditions/History EMERGENCY MEDICAL INFORMATION
SAMPLE History to gain essential information about the patient’s medical history, ask the patient questions, such as: • S = Signs and symptoms . What are your signs and symptoms (i.e., what hurts)? Are you experiencing any pain, nausea, lightheadedness or other things that are not visible? • A = Allergies . Do you have any known allergies or allergic reactions? What happens? Has there been any recent exposure? • M = Medications . What medications are you taking? Are they over-the-counter or prescription? What is the medication for? When was it last taken? Where is the medication so we can keep it with you? • P = Pertinent past medical history . Has anything like this happened before? Are you currently under a health care provider’s care for anything, such as for a cardiac or respiratory condition? Have you recently had surgery? Are you pregnant (if a woman)? • L = Last intake and output . When did you last eat or drink? How much? Are you hungry or thirsty? When did you last urinate and defecate? Were they normal? • E = Events leading up to the injury or illness . What led up to the incident? When did it happen? How did it happen?
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 Increments Axial Movement is Usually Best Always Maintain HOS Avoid Pushing or Pulling (Try to Lift)
IMMOBILIZE A SUSPECTED SPINAL INJURY
The spinal column of the neck and back surrounds and protects the nerves of the spinal cord. If the spinal cord is cut, the muscles and sensations controlled by the portion of the spinal cord below the cut will not function. Always check a patient who may have fallen or been hit in the back for spinal injury. If the patient has suffered a severe head injury, assume the patient also has spinal damage.
IDENTIFY SIGNS AND SYMPTOMS OF A FRACTURED SPINE
Pain or tenderness of the neck or back.
Cut or bruise on the neck or back.
Inability to move part of the body (paralysis), especially the legs.
Lack of feeling in a body part.
Touch the patients arms and legs and ask if he feels your hand.
Loss of bladder and/or bowel control.
Head or back in an unusual position.
MOVE A PATIENT WITH A SUSPECTED SPINAL INJURY, IF NECESSARY
Do not move a patient with a suspected spinal injury unless it is necessary to save his life, such as moving the patient from a burning building or positioning a non-breathing patient to perform mouth-to-mouth resuscitation.
Use a four-man arms carry to move the patient to a place of safety.
One rescuer will kneel at the patient’s head and places his hands on both sides of the patient's head. This bearer keeps movement of the patient's head and neck to a minimum when the patient is moved.
This person will be in charge and will give the command to lift on 3.
IMMOBILIZE THE PATIENT’S SPINE
Do not attempt to straighten the patients neck or back if it is in an abnormal position.
Tell the patient to keep still and avoid unnecessary movement.
Send someone to get medical help. (if possible)
If the patient is lying on his stomach, keep him from moving until medical help arrives.
If the patient is lying on his back, use padding to help immobilize his back, neck, and head as described below .
IMMOBILIZE THE PATIENT’S SPINE
Roll or fold a blanket or similar padding to conform with the normal shape of the arch of the back. Carefully slide the padding under the arch of his back.
Slide a roll of cloth under the patient’s neck to help support and immobilize his neck.
Keep patient’s from moving.
Cold Emergencies Frostbite 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
Cold Emergencies Frostbite, 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 minutes to hours after thawing blisters will develop. Blisters may be 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
Cold Emergencies Frostbite, 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 104 0 to 108 0 and leave it in until completely flushed. Protect from refreezing Never massage/use radiant heat Full Thickness: Avoid field rewarming. Allow patient to walk out if prudent. If evacuation delayed consider field rewarming Protect from refreezing Administer STRONG pain med’s, if available. (Include ibuprofen to reduce tissue damage) Evacuate ALL full thickness frostbite Evacuate if blisters form
Cold Emergencies Hypothermia Definition: A lowering of the core temperature of the body to the level that brain function is impaired. Causes of Hypothermia: Acute Exposure: Immersion/Submersion in water. Occurs in less than One hour Body 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 skills Shivering “ Umbles” Begin “ UMBLES” Fumbles Mumbles Grumbles Stumbles Moderate: Uncontrollable shivering Worsening of “Umbles”
Cold Emergencies Hypothermia, 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 shelter Remove wet clothing and replace with dry Insulate patient from cold (Hypothermia Wrap?) Keep patient moving if able Create external heat source: Fire, stove, heat packs Give warm, sweet fluids (No caffeine, alcohol) (Only if they can drink without assistance) Have patient eat if possible Food Chain for Revival To stoke the bodies furnace compare it to starting a fire Kindling Small sticks Logs Simple sugars Complex carbs. Proteins/Fats
Cold Emergencies Hypothermia, 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 possible Cold Weather Guidelines: Know your environment and be prepared Pay attention to yourself and your companions Dress to maintain warmth and dryness Stay well fed and well hydrated Stay dry. Avoid overexertion Carry emergency food and clothes Avoid tight clothes and boots Do not sleep with wet, cold feet Avoid alcohol,caffeine, nicotine and other vasoconstrictors
Open chest wounds
Object penetrates the chest wall
Fractured ribs break through the skin
Closed chest wounds
Generally due to a blunt object
Chest Injuries: Signs and Symptoms
Difficulty breathing, including shortness of breath and pain when breathing (especially deep breathing)
Pain at the site of the injury
Pale or bluish skin
Coughing up blood
Protruding neck veins
Drop in blood pressure
Sucking Chest Wound: Care
Cover with an occlusive dressing, taping it in place on all sides except for one side that should remain loose.
Use a folded cloth or, as a last resort, a gloved hand if occlusive dressing not available.
Administer emergency oxygen, if available, and take steps to minimize shock.
Have patient sit or lie in a comfortable position if no spinal injury is suspected.
Impaled Object in the Chest: Care
Never remove the object unless it interferes with chest compressions.
Stabilize the object to prevent further damage.
Remove clothing to expose the wound.
Control bleeding by applying direct pressure to the edges of the wound; avoid direct pressure on the object.
Use a sterile, bulky dressing to help hold the object in place, carefully packing the dressing around the object.
Secure the sterile bulky dressing in place with gauze, a cravat or tape.
Severity of a burn depends on the―
Temperature of the source of the burn.
Length of exposure to the source.
Location of the burn.
Size of the burn.
Patient’s age and medical condition.
Classifications of Burns
Body part burned
Depth of Burn
Partial thickness (involving epidermis and dermis)
Full thickness (destruction of epidermis and dermis and any or all underlying structures [fat, muscle, bones and nerves])
Extent of Burn
Rule of Nines
11 sections, each comprising 9 percent of the body’s skin coverage
1 percent for genital area
Lund-Browder diagram for children
Soot or burns around the mouth, nose or rest of face
Inhalation of superheated air or smoke and toxic gases
Thermal Burns Signs and Symptoms
Painful, appear as a reddened area that turns white when touched, do not produce blisters and have skin that appears moist
Superficial partial-thickness burns:
Painful; have a red area that turns white to touch; the skin may have mottling, blisters and may appear moist; and the hair is still present
Thermal Burns Signs and Symptoms (cont’d)
Deep partial-thickness burns
May or may not be painful (nerve endings may be destroyed); moist or dry (sweat glands may be destroyed); may or may not turn white when the area is touched; and hair usually is gone
Painless, no sensation to touch, pearly white or charred, dry and may appear leathery
Thermal Burns: Care
Scene size-up for safety
Removal from burn source
Primary assessment; physical exam
Cooling of burn area
Covering of burn area
Altitude Sickness –Although the amount of oxygen in the air above 7,000 feet is the same as at sea level, the pressure is much less, so the circulatory system has to work harder to get the O2 through the alveoli in the lungs and into the bloodstream. Acclimating slowly to higher altitudes allows the body to develop more blood cells, which in turn increase the amount of oxygen delivered into the circulatory system with each breath. Altitude sickness is more common with younger people than older. Anyone with a history of hypertension or other pre-existing conditions is also more susceptible. An early symptom is feeling out of breath while resting, or a pounding headache. When fluid starts filling the lungs, the condition is known as High Altitude Pulmonary Edema (HAPE). The victim spits up a pink frothy sputum and can only sleep sitting up. Edema (swelling) in other parts of the body may occur, and you may wake from a sound sleep feeling as if you're drowning from the inside out. The general rule for treating altitude sickness is "Descend, descend, descend." If you have access to oxygen, use it. The patient shouldn't be allowed to sleep during the critical period of the illness. However, caffeinated drinks should not be given. A related condition is known as High Altitude Cerebral Edema (HACE). Symptoms of this are Ataxia (remembered as: the victim stumbles along like they need a taxi...), headache, nausea and Disoriented Irritable Combative behavior. HACE is treated by descending in altitude, giving oxygen if you have it .
Antelope Mesa - 7,624 ft Deer Lake Mesa - 8,261 ft Midnight Mesa - 8,326 ft Urraca Mesa - 8,531 ft Wilson Mesa - 8,602 ft (Part of this mesa lies outside of Philmont property) Fowler Mesa - 9,419 ft Mesas Hart Peak - 7,975 ft Shaefers Peak - 9,413 ft Crater Peak - 9,730 ft Rayado Peak - 9,790 ft Apache Peak - 9,856 ft Lookout Peak - 9,927 ft Burn Peak - 9,936 ft Trail Peak - 10,250 ft (This peak has a B-24 bomber crash site on it) Cimarroncito Peak - 10,475 ft Bonito Peak - 10,610 ft Bear Mountain - 10,662 ft Black Mountain - 10,889 ft Garcia Peak - 10,929 ft Big Red - 11.020 ft Comanche Peak - 11,303 ft Mount Phillips - 11,736 ft (This mountain is named after Waite Phillips, the founder of Philmont ) Touch-Me-Not Mountain - 12,044 ft (This peak is just outside of Philmont's property) Baldy Mountain- 12,441 ft (This is the highest and most visited peak within Philmont Scout Ranch) Mountains