WildernessFirst Aid

Introduction

WildernessFirst AidHS 223

Midterm test Review

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 Blood Pressure

Normal Adult Blood Pressure

120/80

FREE FLOW FLOW STOPPED EQUAL FREE FLOW

SYSTOLIC

DIASTOLIC

SOUND

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

BloodPressure

WildernessFirst Aid Blood Pressure

BloodPressure

Estimated Blood Pressure from Pulse Points

Can only determine Systolic Number

Carotid……….…….50Brachial……………60Femoral……………70Radial………………80Pedal…………….…90

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

•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