Heat Illness

Thermoregulation
Excess heat is absorbed by blood.
Brain detects increased blood temp and
causes peripheral dilation.
Brain causes sweating to begin.
As long as sweating continues your body is
cooled.

Heat Illness
Dehydration
Dehydration
You are approximately 62 % water!
Water is in every cell
Water lubricates joints
Digestion and metabolism are water based
processes.
Average person at rest on a normal day loses
b/t two and three liters of water per day.
Fluid lost in perspiration can climb to 2 liters
per hour during strenuous exercise.

Environmental
Dehydration
Down 1.5 liters may reduce your
endurance by 22%
Down 3-4 liters can reduce your
endurance by 50%

Environmental
Dehydration
Levels of dehydration
Mild
dry lips and mouth
Dark urine
Mild thirst

Moderate

Very dry lips and mouth

Rapid weak pulse
Darker urine
thirst

Severe
Altered LOC
No urine, tears
shock

Heat related illness can be caused by:

Dehydration and salt loss from sweating
Severe dehydration when you can no longer
sweat.
Humidity sweat cant evaporate- no cooling
effect.
A continuum mild can progress to severe catch
it early.
Predisposing factors: age (very old and very
young), poor health, fatigue, certain meds,
ETOH consumption, heart disease.

Heat Cramps
Heat cramps: painful spasm of major
muscles being exercised.
Most often occurs in people unacclimatized to
heat and who are sweating profusely.
Probably a result of water and salt loss.
Treatment
Rest and massage muscles
Hydrate (water with a pinch of salt)

Heat Exhaustion
Heat Exhaustion (dehydration and salt depletion)

Headache
Dizziness
Nausea
Increased HR
Increased RR
Fatigue
Thirst
Pale, cool skin

Heat Exhaustion
Heat Exhaustion Treatment
Move to a cool environment
Fan, pour water on head.
Apply cool cloths to body
Remove excess clothing

Hydrate
Water with salt (and sugar)(1 liter water + 1 t. salt) (+2T sugar)
Gatorade (watered down 4 X)
Pt can resume activity in 6 to 8 hours or less

Heat Stroke
Life-Threatening
Heat Stroke
More serious (kills 4,000 people in U.S. per yr)
Death can occur w/i 30 mins.
Classic heat stroke
Patient usually elderly or sick
High temps/humidity for several days
Patient dehydrated, patient runs out of sweat

Exertional heat stroke

Patient usually young and fit and not used to heat
Sweating but producing heat faster than it can be shed

Heat Stroke
Signs and Symptoms
Altered LOC
Increased HR
Increased RR
Loss of coordination
Seizures (may have)
Hot, red, wet (exertional) dry (classic)
Core temp is at least 105

Environmental
Heat Stroke
Treatment
Remove from sun and heat
Rehydrate
When conscious

Rapid Cooling

Cover with wet cotton clothing and fan

Massaging arms and legs(encourages hot blood to extremities)
Ice packs at neck, groin and armpits
EVAC do not allow Pt to exercise

Environmental
Heat illnesses
Prevention
Start each day with a half liter of water.
3 to 4 liters of water per day.
Cold water (low 40s) is emptied faster
Small amount of salt helps water retention
Rate of absorption
liter per hour
Max efficiency liter every 15 mins during
exercise.

Heat Illness
Prevention
Avoid

Salt tablets (draw water to stomach to dilute salt)

Alcohol: draws water out of cells
Fruit juice: too much sugar
Allow time to acclimate to new conditions

Environmental
Immersion/Submersion
Immersion- a patient who can breath
Submersion- can not breath
9,000 deaths per year, second or third cause
of accidental deaths in last several years.

Environmental
Immersion/Submersion
Death by drowning facts
Many were non-swimmers
Most not wearing PFDs
Some white water paddlers not wearing
helmets
One study estimates more than half involved
alcohol or drugs
Immersion hypothermia large factor
Males outnumbered females 12-1 in boating
related deaths

Environmental
Immersion/Submersion
Submersion
Series of events
Drive to breath becomes overpowering, person inhales
water.
Larygnospasm- involuntary constriction of upper airway
muslces.
Asphyxia (inadequate O2 intake)
Loss of consciousness
Laryngospasm relaxes, water enters lungs (wet drowning)
Some people have a second larygnospasm accounting for a dry
drowning

Respiratory arrest
Cardiac arrest
Laryngospasm (if present) relaxes.

Environmental
Immersion/Submersion
Treatment
Immediate rescue breathing.(start in water)
Fresh water better chance of survival
Water moves from lungs to blood more easily.

Begin chest compressions

Expect vomit
Chances to survive best, younger, shorter
time under water, cold clean water, early CPR

ReachThrowRowGo

Principals:
Think prevention
Do not become a second victim
ABCs attention
Suspect spinal if MOI

Altitude Illness
All are a result of hypoxia
High altitude
Starts at 4,000
Complications seldom occur below 8,000
8,000-12,000 High
12,000-18,000 Very high
18,000 + extreme
Oxygen pressure that of sea level

Altitude Illness
Acclimatization: process of physiologically
adjusting to altitude
2 3 days b/t 8,000 12,000 and not gaining more
than 1,000 feet of sleeping altitude
Hydration and nutrition
Rest and light exercise
Stages

Increasing ventilation- increase O2 content of blood.

HR speeds and BP increases.
Increased red blood cell production- more O2 in blood
Cell modification- more O2 used quicker
80% acclimatized at 10 days. 95% at 6 weeks.

Altitude Illness
Acute Mountain Sickness

Most common altitude illness

Presents between 6-48 hrs.
Headache
Anorexia
Nausea
Perhaps vomiting
Insomnia
Psychological weariness
Fatigue
Shortness of breath on exertion

Altitude Illness
Ataxia
Loss of muscular control, difficulty maintaining
balance.
Most useful sign indicating a patient is
progressing from mild/moderate altitude
illness to severe

Altitude Illness
High altitude Pulmonary Edema
Most common severe altitude illness
Shows within 3 days
Fluid seeps out of pulmonary capillaries and fills
alveolar spaces.

Signs/Symptoms
Shortness of breath: unrelieved by rest
Cracking and/or gurgling breath sounds: audible to
naked ear
Increasingly productive cough
Increased HR
Chest pain

Altitude Illness
High Altitude Cerebral Edema
Fluid collects around brain
Can appear suddenly and kill quickly

Signs and Symptoms

Ataxia
Headache: constant throbbing unrelieved by rest or meds.
Lethargy
Weakness
Vomiting
Personality changes:
coma

Gamow Bag

Gamow bag pressurized 5,000

difference between pressure inside
and pressure outside bag.

Altitude Illness
Treatment

Dont ascend until symptoms have resolved.

Maintain adequate hydration and nutrition. Light exercise.
Pain medication as needed for headache.
Acetazolamide, 250mg PO every 6 to 12 hours, for
mild/moderate AMS.
If symptoms do not improve over 24-48 hours, descend until
symptoms abate. Generally 2000 feet (610m) is adequate.
If patient has HAPE or HACE, descent is critical. 2000-4000 feet
(610m-1219m) can make a remarkable difference.
Oxygen will be helpful, if available, especially for HAPE.
Nifedipine, 10-20mg PO every 8 hours (for HAPE) and
dexamethasone 8mg PO or 10mg IM followed by 4mg every 6
hours PO or IM (for HACE).
Gamov Bag, can make a patient ambulatory for self-evacuation.

Evacuation Guidelines
Evacuate Rapidly:
Any patient unable to acclimatize.
Any patient with severe altitude illness.

Lightning

Lightning
Occurs most often on hot days
Warm moist air rises rapidly forming clouds with static electricity.

Opposite charges develop on the top and bottom of the

cloud and on the ground.
Difference between charges reaches potential greater than the air
can insulate and BOOM.

Lightening bolt
200 million volts, 300,000 amps
14,432 degrees F
Can strike miles in front of a storm

Second only to flash floods in deadliness of natural

disasters.
Can calculate distance delay between flash and rumble: 5
seconds =1 mile. Storms travel at 20-25 mph.

Cumulonimbus clouds

Average U.S. Thunderstorm

Days/Year

Types of strikes
http://www.lightningsafety.com/nlsi_info/4_different_types.html

Lightning
Places to avoid
Mountain tops and summits
Ridges and cliff tops
Overhangs and shallow caves
Ditches, gullies and streams
Tall trees, poles, large boulders, high objects
Open areas

Lightning
Mechanisms of Injury
Direct strike
Splash
Contact
Ground current
Blast effect

Lightning Strike Probabilities

http://www.lightningsafety.com/nlsi_pls/probability.html

USA population = 280,000,000

1000 lightning victims/year/average
Odds = 1 : 280,000 of being struck by lightning

Lightning
Lightning Demythed
Lightening will strike twice.
Not stored by the body.
Will strike before, during, and after a storm.
Can cause internal injuries with no external
signs.
Can cause injury that does not appear until
well after the strike.

Lightening
Types of Injuries
Cardiac Arrest: natural rhythm upset
Respiratory Arrest:
Neurologic Injury: seizures or paralysis
Burns: usually superficial
Trauma
Ringing in ears
Rupture of eardrum

Lightening
Management
Opposite of standard
triage (treat
unconscious first)
CPR is very effective!
80 %

http://www.kidslightning.info/lsaftposi.htm

 Prevention
Know weather patterns
Time your activities
Know where to find safe terrain
Choose safe tent sites
Spread groups out
Lightening position

Lightning struck this tree and boiled

the roots, causing them to explode
out of the ground

Lightning strikes telephone pole:

note attraction of many bolts to this
point.

Lightning usually, but doesnt

always strike the high point

Lightening Treatment
Scene safety: Lightning will strike twice in
the same spot.
Aggressive Basic Life Support: Rescuers
should be prepared to provide prolonged
rescue breathing.
Thorough patient exam and treatment of
any injuries found.
Monitor closely for cardiovascular,
respiratory and neurological collapse.

Lightening Evacuation Guidelines

Evacuate Rapidly:
Any patient showing signs of cardiovascular,
respiratory or neurological compromise.

Evacuate:
Any patient struck by lightning even if they
appear uninjured.

Environmental
North American Bites and Stings
Treatment of all bites and stings
Scene safety
Stop blood loss
Cleaning the wound
Reducing the effects of envenomation

Environmental
North American Bites and Stings
Black Widow
4 species in U.S.
Cosmopolitan: found
around the globe.
More danger in every
drop of venom than
any creature in North
America.
Hour glass shape on
abdomen

Environmental
North American Bites and Stings
Black Widow
Signs and symptoms
Patients almost never feels bite
Fever, chills, cramps, rigid abdomen, elevated BP
Kill very few humans

Treatment

Calm patient
Wash and apply anticeptic
Apply cold if bite just occurred
Evac

Environmental
North American Bites and Stings
Brown Recluse
Pale brown to reddish, painful bite
Most common serious spider bite in U.S.
Violin shape on top of body
Both sexes dangerous
Prefer dark, dry places of South and Southern
midwest, but travel in freight.
Found in curtains, closets, rocks, bark.

Brown Recluse

Environmental
North American Bites and Stings
Brown Recluse
Signs and symptoms

Infection, seeping ulcer at bite site

Bulls eye lesion
Chills, fever
Treatment: calm, clean wound site, mark margin,
evac, monitor for Anaphylaxis

Brown Recluse Spider Bite

Brown Recluse bite

Brown Recluse bite

Brown Recluse bite

Environmental
North American Bites and Stings
Black Widow
Hour glass
More shy
Less territorial

Brown Recluse
Violin thorax
Less tolerant
More territorial

Environmental
North American Bites and Stings
Scorpions
Nocturnal
Sting with tail: feels like a bee sting
Centruroides: only known killer in U.S.

Yellow or yellow with dark stripes

1-3 inches in length
Long slender pincers
Found in Mexico and extreme SW U.S.

Centruroides

Environmental
North American Bites and Stings
Treatment for Scorpion sting
Cool: allows body to break down venom.
Keep patient calm and still.
Quick evac
Possible signs and sx
Heavy sweating, difficulty swallowing, blurred
vision, incontinence, respiratory distress

Treatment for Bites and Stings from North American

Spiders and Scorpions

Clean the bite/sting site. Continue to

clean the site if wound does not heal.
Ice the bite site for pain and consider
painkillers for abdominal cramps.
Monitor the bite site for necrosis.
Monitor the patient for systemic signs and
symptoms.
Calm patient

Evacuation Guidelines for Bites and Stings from North

American Spiders and Scorpions

Evacuate Rapidly:
Any patient exhibiting slurred speech, difficulty
swallowing, blurred vision, seizures, or
respiratory or cardiovascular involvement.

Evacuate:
Any patient with a suspected black widow
spider bite.
Any patient with a wound that will not heal.

Environmental
North American Bites and Stings
Reptiles
Deaths are unusual
Arizona most likely place to die
Top 5
FL, GA, TX, AL

99/100 poisonous bites from pit vipers

Rattlesnakes
Copperheads
Water moccasins

Environmental
North American Bites and Stings
Pit vipers (rattlesnakes, copperheads and water moccasins)
Triangular heads
Cat like pupils
Heat sensitive pits between eyes and nostrils

Cottonmouth

Copperhead

Eastern Diamondback

Environmental
North American Bites and Stings
Danger of pit viper bite depends on

Age, size, health, and emotional stability of patient.

Allergic reaction to venom
Where bite occurred
How deep fangs go
How upset snake is

Sx
Mild: hurt swell turn black and blue
Mod: swelling both distal and proximal, numbness,
swollen lymphs, blisters, nausea
Severe: rr and hr increase, profound swelling, blurred
vision, headache

Treatment of Pit vipers

Tx

Calm
At rest with bite same level as heart. Keep pt warm
Remove constricting jewelry if swelling occurs
Wash
NO COLD
Evac by carrying or slow walk if pt stable
Hydrate (unless vomiting)
Attempt to identify creature if not endangering
yourself
Lymphatic compress: distal to proximal and then
proximal to distal. 6 ACE. Immobilize.

Environmental
North American Bites and Stings
Coral Snakes
Red, yellow, and black
Short fixed fangs: only able to bite a finger,
toe, or fold of skin. Have to hang on and
chew.
Very powerful neurotoxin, bites are rare
Red on black, venom lack, red on yellow, kill a
fellow

Coral Snake

Scarlet King Snake

False Coral

Environmental
North American Bites and Stings
Lizards
Only two worldwide venomous enough to kill a
human. Both found in South West U.S.
Gila Monster
Mexican Beaded Lizard
Will bite when stepped on
Lock on while venom drools into wound
May have to heat underside of jaws to break grip

Gila Monster

Beaded Lizard

Environmental
North American Bites and Stings
Treatment for Reptile Bites
Ensure the scene is safe. Remain calm and put the patient at
rest. Avoid walking if possible.
Remove constricting clothing and jewelry from the bite site.
Wash and dress the wound.
Measure and monitor swelling and signs of envenomation. Do
not apply cold.
A wide elastic bandage wrapped proximal to distal is
recommended for coral snake bites.
Splint the extremity and keep it at the same level as the heart.
Monitor for shock and cardiac and respiratory depression.

Environmental
North American Bites and Stings
Evacuate Rapidly:
Any patient exhibiting shock, or cardiac or
respiratory depression.
Evacuate:
Any patient bitten by a poisonous snake,
ideally by carrying or slowly walking.

Environmental
North American Bites and Stings
Treatment Donts
Do not cut and suck:
Do not give pain killers: may mask important
symptoms
Do not apply ice or cold water: may drive
venom deeper
No alcohol

Environmental
North American Bites and Stings
Prevention
Do not pick up or capture reptiles
Check hand and foot placements
Gather firewood before dark
Keep your tent zipped up
Wear high thick boots in snake country
Stay out of striking range, snakes length

Environmental
North American Bites and Stings
Ticks
Two sizes: Tiny and
hard to find, and big
and easy to find.
Feeds for an average
of 2-5 days and drops
off weighing hundreds
of times more.
Worldwide only the
mosquito spreads
more illness.

Environmental
North American Bites and Stings
Lyme Disease
Bacteria: Borrelia burgdorferi
Heaviest concentrations in Northeast and upper
Midwest and coast of Northern CA.
Tick must be attached for 48 hours to spread Lyme.
Warning signs
Ragged bulls eye (2 days to 5 weeks) appears anywhere.
60-80% of patients
Flu-like symptoms
Extreme chronic fatigue
Swelling and pain in joints (up to 2 years after)

Environmental
North American Bites and Stings
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a4.htm

Environmental
North American Bites and Stings
Tick Removal
Dont smear with petroleum jelly, nail polish,
or burn with a match.
Pull out gently with tweezers.
Dont twist, yank, or squeeze

Clean the area and apply antibiotic ointment.

Use DEET or Permethrin

Environmental
North American Bites and Stings
Tick Removal

Environmental
North American Bites and Stings
Stinger Removal

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19629.htm

Environmental
North American Bites and Stings
Hantavirus Infection
Carried by deer mice and other rodents.
Primarily Southwestern U.S.
Inhaling aerosolized microscopic particles of dried
saliva, urine, or feces passes the virus.
Causes extremely dangerous respiratory syndrome.
of cases have died.

Symptoms
Flu- fever, achy muscles, headache, cough
Sudden onset of fluid in the lungs and respiratory failure.

Environmental
North American Bites and Stings

Environmental
North American Bites and Stings
http://www.cdc.gov/ncidod/diseases/hanta/hps/noframes/casemap.htm

Environmental
North American Bites and Stings
West Nile Virus
Serious Symptoms in a Few People. About
one in 150 people infected with WNV will
develop severe illness.
Milder Symptoms in Some People.
Up to 20 percent of the people who become infected
will display symptoms
No Symptoms in Most People. Approximately 80
percent of people (about 4 out of 5) who are infected
with WNV will not show any symptoms at all.

2004 West Nile Virus Activity in the United States

(reported to CDC as of November 8, 2004)*

Environmental
North American Bites and Stings
Bears
Polar Bear
Black Bear: Most widespread
Jet black to creamy yellow

Brown Bear
Dark brown to blond
Prominent shoulder hump and dished face.
Kodiak
Grizzly

Brown Bear

Black Bear

Treatment for Zoonoses

Symptomatic management, e.g. fever
reducing medication, pain medication,
antihistamines and antibiotic therapy.
Treat all mammal bites as a potential rabies
exposure. Clean wound thoroughly with
soap and disinfected water.

Evacuation Guidelines for

Zoonoses
Evacuate Rapidly:
Any patient with a mammal bite for initiation of
the rabies vaccine.

Evacuate:
Any patient with a history of an embedded tick
who develops fever, rash and flu-like
symptoms

Environmental
North American Bites and Stings
Marine Life
Ocean covers 71% of the earth.
Contains four-fifths of worlds living
organisms.
Categories of potentially dangers animals
Those with big teeth
Those that envenomate
Those that sting with nematocysts

Environmental
North American Bites and Stings
Those with big teeth
Sharks
Account for most human deaths annually from marine life.
Average 50-100 a year.

Reducing risk of shark attack

Swim in groups
Dont swim at dusk or at night
Wear bright swimsuits
Avoid turbid water
Avoid erratic movement
Be extra careful if you spear fish

Tiger Shark

Great White

1580-2003 Map of World's Confirmed Unprovoked Shark Attacks (N=1909)

http://www.flmnh.ufl.edu/fish/Sharks/ISAF/ISAF.htm

1670-2003 Map of United States (incl. Hawaii) Confirmed

Unprovoked Shark Attacks (N=833)

400 and above

76-399

10-75

1-9

Environmental
North American Bites and Stings
If a shark attacks
Face it and swim away slowly
Curl into a ball
Kick and punch at the eyes, nose, and gills

Environmental
North American Bites and Stings
Moray eels
Has to be killed to be removed.
Divers should take caution around coral holes
and rock crevices.

Barracudas
Rarely attack humans, usually in murky
waters.

Moray eel

Barracuda

Environmental
North American Bites and Stings
Treatment for marine animal bites
Stop blood
Clean wounds thoroughly
Humans deal poorly with marine bacteria
Have wound seen by a physician.

Environmental
North American Bites and Stings
Those that envenomate
Venomous sea creatures usually nonaggressive.
Bite when stepped on or handled.
Most common are sea urchins and stingrays.
Symptoms
Local burning pain
Redness, swelling, and aching.

Sting ray

Sea urchin

Environmental
North American Bites and Stings
Treatment
Clean immediately with sea water.
Look for pieces of the creature in the wound.
Scrub with PI.
Soak in hot water, may further reduce venom
and pain.
Use a loose bandage
Allows wound to drain, high infection rate.

Environmental
North American Bites and Stings
Those with nematocysts
Nematocysts: stinging organelle.
Man of war, sea wasp, sea nettle. Includes all
jellyfish.
Reactions
Stinging, burning, itching, numbness
Headache, nausea, vomiting
Loss of consciousness, convulsions, death.

Man o War

Stinging Organelles of a man o war

http://www.aloha.com/~lifeguards/portugue.html

Dangerous Hawaiian Marine Life

http://www.aloha.com/~lifeguards/portugue.html

Environmental
North American Bites and Stings
Treatment
Leading cause of death is drowning: remove
from water!
Rinse with sea water, fresh may stimulate
nematocysts to fire.
Remove tentacles w/o touching
Wash organelles with vinegar (alcohol,
ammonia and urine also work)
Form a paste with meat tenderizer.

Environmental
Allergic Reactions
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19150.htm

Environmental
Allergic Reactions
Allergies are common over 50% is
affected
6th leading cause of chronic disease
Four classes
Food- 30% of population
Drugs- 7% of population allergic to penicilin
Insects- 3%
Latex- 1-6%
Anaphylaxis- 500-1000 deaths annually

Environmental
Allergic Reactions
Common Food Allergies
Peanuts
Tree nuts (walnuts, pecans, etc.)
Shellfish
Fish
Milk
Soy
Wheat
Eggs

Environmental
Allergic Reactions

Common Medicine Allergies

Penicillin
Sulfa antibiotics
Allopurinol
Seizure and anti-arrhythmia medications
Nonsteroidal anti-inflammatory drugs (NSAIDS,
such as aspirin and ibuprofen)
Muscle relaxants
Certain post-surgery fluids

Environmental
Allergic Reactions
Common Insect Allergies

Bees
Wasps
Yellow jackets
Hornets
Ants, especially the fire ant

Environmental
Allergic Reactions
What is an allergy?
Hypersensitivity to an antigen
Antigens- proteins, pollens, viruses, bacteria,
parasites

Environmental
Allergic Reactions
Immune response
Antigen exposure = release of inflammatory
mediators
Histamines, leukotriene, prostaglandin, etc

Antigens are presented to the antibody factory

Antibodies produced
Immunity- immune system deals quickly with invader
Sensitivity- immune system overreacts
Too much histamine

Environmental
Allergic Reactions

Runny Nose
Sneezing
Itchy
Scratchy throat
Sensation of tight
throat
Slight cough
Minor wheezing
Mild, red, itchy rash

Environmental
Allergic Reactions

Environmental
Allergic Reactions
Anaphylaxis- S/S
SOB
Wheezing
Difficulty breathing
Shock

Environmental
Allergic
Reactionshttp://www.allergic-reactions.com/epipen_main.html

Epinephrine (adrenaline)
Reverses symptoms of an anaphylactic
reaction.
constricts blood vessels, relaxes smooth muscles
in the lungs to improve breathing,
stimulates the heartbeat.
Reverse hives and swelling around the face and
lips (angioedema).

The effects of epinephrine usually last 10 to 20

minutes.

Epi-pen

Allergic Reaction TX
Treat the bronchoconstriction
EPI!!

Treat the Vasodilation

Admininster oral antihistamines
Diphenhydramine (Benadryl) 50mg 100mg every
4-6 hours

Allergic Reaction Evacuation

Guidelines
Evacuate Rapidly:
Any patient who continues to show respiratory
compromise or signs and symptoms of shock
after treatment with epinephrine and
antihistamines.

Evacuate:
Any patient who has received epinephrine.
Continue to provide anti-histamines during
evacuation.

Environmental
Ingested Poisons
Fatal poisonings in the wilderness are rare
Cooking in an inadequately ventilated snow
cave or tent.
Ingesting a poisonous plant.

Environmental
Ingested Poisons
Mushrooms- 90% from death cap
Fatal liver and kidney failure in 2-3 days.
Nausea, vomiting, abdo cramps, diarrhea.
Onset in 6-12 hour range
If onset is in the 2 hour range unlikely that it is a
fatal mushroom.
Hurry to hospital

Death Cap

Environmental
Ingested Poisons
Jimsonweed
Brewed into a lethal tea
Contains alkaloids, used in proper doses in
motion sickness patches.
Most deaths are caused by voluntary
ingestion (seeking a hallucination)

Jimson Weed

Hemlock

Environmental
Ingested Poisons
Water Hemlock
One mouthful of root will kill a large adult

Poison Ivy

QUIT SMOKING

Environmental
Ingested Poisons
Treating ingested poisons
Limit absorption of poison
Dilute with water
Chemicals or petroleum products

Inducing vomiting
Very beneficial if done within an hour, especially for
mushroom
Syrup of ipecac
Dont do this for chemicals or petroleum products

Binding with activated charcoal

50-100 grams for adults, 20-50 for children
May be used post vomiting

Environmental
Ingested Poisons
Carbon monoxide
of poisoning deaths each year.
Bonds to hemoglobin in RBC, interferes with
O2 delivery.
Headache, nausea, vomiting
Irritability, impaired judgment, confusion
Coma

Psychological/Behavioral
Crisis- unstable period when people have
to respond and adapt to unusual/critical
changes.
Running out of food
Injured group member

Responses to Crisis
Regression- reverting to an earlier stage
of development
Depression- closing into ones inner world
Fetal positioning
Slumped shoulders, etc.

Aggression- lashing out

Explosive body language

Crisis Management
Engage the patient in a calm, rational
discussion
Identify the stress points
Provide realistic and optimistic feedback
Involve the patient in solving the problem

Repetitive Persistence
Remain calm but firm
Choose a positive statement that includes
the persons name.
Frank, we can help once you calm down

Persistently repeat the statement with the

same words in the same tone of voice.

Critical Incidents
Any incident in which the circumstances
are so unusual or the sights and sounds
so distressing that an individuals normal
coping mechanisms are overwhelmed.
Acute: person non-functional by situation
Delayed: signs and symptoms appear later

Factors affecting CIS

Age: older people do better
Education
Duration of event:
Suddenness and intensity

Resources available for help

External or internal

Level of loss

Signs and Symptoms

Physical
Fatigue, sleep dysfunction, change of
appetite, headache

Emotional
Anger, irritability, fear, grief, guilt

Cognitive
Memory loss, attention span, etc.

CIS management
Remove the person with acute stress
Defusing: within a few hrs.
Informal discussion
Not a critique of how event was handled

Debriefing Facilitated by a trained group

#1 Fall on Board Ship

Subjective

Date: ?
Name/sex/age:40 y/o female, name unknown
MOI: Tripped and fell down a companionway, landed on a table.
CC: Pt. stated lower back pain and wind knocked out of me
HPI:
Onset Palliate Quality Radiate Severity Time-

#1 Fall on Board Ship

Objective
Vitals
T

HR RR

b/p

skin

LOC

1100 98 22

122/ pale 78

A&O x 4

1130 72 14

116/ w/p
76

A&0X4

Pt. exam
Head to toe exam
revealed lower back pain,
tenderness in left flank (no
bruising). Soft, non tender
abdo. Normal CSMs

# 1 Fall on Board Ship

Objective (Cont.)
S: c/o lower back pain, bruising found @ 1130
in L flank
A: non known
M: non known
P: none
L: Breakfast 0800
E: Walking down companionway

# 1 Fall on Board Ship

Assessment 1100

Left flank tenderness

MOI for spinal injury
Stress
Shock

Assessment 1130
Left flank
bruising/tenderness
MOI for spinal injury

Plan

Monitor, EVAC
Immobilize
Reassurance
Reassurance, keep
warm

Monitor, EVAC
Immobilize

#1 Fall on Board Ship

The pt. remained stable through the 8 hr.
evacuation to shore and the nearest
hosptial. She was observed overnight and
released the following day with a Dx of
kidney contusion. The pt. did not sustain
a significant spine injury but was sore for
days following the incident.

Climbing Specific Injuries

Shoulder
Elbow
Fingers

Shoulder
Injury is to the rotator cuff Supraspinatus
Infraspinatus
Subscapularis
Teres minor

Caused by
Falling onto your arm
Lifting heavy objects
Repetitive overhead movement

Shoulder Injuries
Symptoms
Pain, weakness, and
loss of movement.

Prevention
Stretching
At least 15 mins.
Stretch in a slow,
focused manner
Shoulder shrug
Deltoid Stretch

Shoulder cont.
Healing
X-rays
MRI
Rest, ice
Anti-inflammatories
Physical therapy

Elbow
Injury is to the tendons that attach to the
epicondyle
Micro tears in tendon.

Elbow
Caused by
Gripping the rock forcefully or dynoing.
Almost always overuse.

Elbow
Symptoms
pain

Prevention
Stretch
Stop climbing when you
feel pain

Healing up
Rest 4-6 weeks
Physical therapy
Anti-inflammatories

Digits
Injury is to the flexor-tendon sheaths or
tears of the pully.
Flexor tendonitis
Flexor-pulley ruptures.

Caused by
Swelling of the flexor tendon sheath
(tendonitis) usually from overuse.
Rupture of the pulley (flexor-pulley ruptures)

Digits
Symptoms
Popping sound
pain

Prevention
Stretching
Refrain from repetitive moves
Keep your feet on.

Healing up
MRI
Tape and anti-inflammatory drugs

Search and Rescue (SAR)

The interview
Who? How long? Why?
Point last seen
Gear, clothing, food, and equipment?
Condition physical/emotional?
Footwear (sole)?
What is the persons
Level of experience
Instructions if lost

SAR
Lost persons walk approx. 2 miles per
hour.
1 hr. = 12 square miles
2 hrs. = 48 square miles
3 hrs. = 108 square miles

SAR
Search Tactics
Passive- does not involve physically
looking for subject or clues
Active- all methods of actively searching
for subject or clues

SAR
Search Tactics- Passive
Fact finding
Attraction- attempting to attract subject to a
location
Confinement- efforts to confine movement of
subject to limit search area.
Blocks
Lookouts
patrols

SAR
Search Tactics- Active
Hasty
Fast initial response
Self-sufficient and very mobile searchers
Check areas most likely to produce clues or subject
soonest.

Efficient
Relatively fast
Systematic search of high probability segments of
search area

Through
Slow, highly systematic

SAR
Hasty Searches
Criteria is SPEED not efficiency or
thoroughness
Objectives
Quickly check specific high probability areas
Obtain info about search area

SAR
Hasty Searches
Hasty Search Considerations
Can help define search area by gathering
intelligence or clues
Victim is usually assumed to be responsive at
this phase
Often determines where not to search futher
Preplanning is essential

SAR
Hasty Search
Hasty Search Techniques
Thorough check of last known point (LKP) or
point last seen (PLS) for clues, track, direction
of travel, etc.
Following known or suspected route
Perimeter check
Check areas of high probability
Hazards, attractions, drainages, buildings, trails,
roads

SAR
Hasty Search
Team usually made up of 3 to 6 searchers
that are immediately available
Usually used early in a search
Can be used anytime to check an
unconfirmed sighting or recheck high
probability areas.

Obstetrical
Normal pregnancy
placenta; provides the blood supply from
the mother to the baby. The membrane
allows O2, CO2, H2O, nutrients and waste
to pass between mother and fetus.
Umbilical cord; the arteries and veins to
pass the materials
Amniotic sac; covers the developing fetus.

Length of pregnancy
40 weeks measured from the beginning
of the last normal menstrual period with
conception occuring approximately 2
weeks later (thus 9 months)

Problems that can occur

Miscarriage or spontaneous abortion:
Common in the first few weeks of pregnancy. Can be
later.
May feel like a slightly delayed heavy period
Menstrual like cramps increasing in pain and
frequency after approx 1-2 hours of heavy bleeding
and hard cramps fetal tissue and placenta are
passed. With in minute cramping diminishes.
No need for medical intervention!
However, if placenta fails to pass blood loss may
become excessive get medical help. To help
contractions simulate breast feeding stroke nipples
1 min every 3 to 4 minutes (release pitocin)

Ectopic Pregnancy
Fertilized egg in abnormal position
(fallopian tube).
Life threatening emergency!
Cramping and bleeding often on one side.
Worsening and does not stop.
Treat for shock and evac.

Placenta Previa
Placenta planted over the cervix may
separate off the uterus when the cervix
starts to thin and dilate. Generally found
on ultrasound. Minimize activity.
Very Heavy painless, bleeding
Cesarean birth required

Placental Abruption
Separation of the placenta off the uterine
wall. Partial or complete.
Bleeding massive of small based on
extent
When it separates it causes contractions
EVAC carefully

Premature Labor
More than 3 weeks early
< 5 pounds
Infant is at risk
Lungs not fully developed
Temperature regulation difficult
Same method of delivery

Normal Childbirth
Estimate time available
1st preg. Longer labor 4-6 hrs.
If first preg. Was short labor 2nd expects to be
shorter etc.
Smaller infant faster labor
Has the water broke membrane rupture
faster labor
Regular contractions q 2 to 3 min. lasting 45
second baby in 1 to 2 hours
Urge to push! Imminent.

Three Stages of Labor

1st: Cervix effaces (thins) and dilates with
each contraction. 8 to 12 hours.
2nd:Pushing of the baby: complete dilation
of cervix (10 cm) to delivery of baby. 30
min to 2 hours.
3: delivery of the placenta. 5-10 minutes

Delivery of the baby

prepare mother
Lye on left side: takes the weight off the uterus.
Can be used as delivery position. Walking is fine
Elevated some off the ground (squatting)
Shelter
Underwear off, clean material beneath, extra to
soak up blood and amniotic fluid
Wash your hands, mothers hands and perineal
(vaginal and rectal) area with soap and water.

Urge to push
birth

Delivery is near
Gently stretch the opening of the vagina between contractions, when the top
of the babies head becomes visible
Once babys head is out to the ears, gently slow the delivery by placing palm
on top of head. Ask the mother to stop pushingask her to bear down
gently allow head to come out slowly
Head usually comes face down clear mucous from mouth rotate head to
face sideways. (one way will be easier than the other.
Next contraction ask the mother to push upper should comes out. Gently lift
babys head for bottom shoulder and chest.
Ask mother to bear down gently the rest will be easy but you want it to go
slowly if she looks down to watch it is easier for her to control her pushing.
Place baby on mothers chest. Wipe the baby, get hair and scalp dry.
Rubbing vigorously helps stimulate especially on back.
If pulse is <100 and baby is limp give mouth to nose ventilations (60/min)
until baby begins to squirm.
Once umbilical cord stops pulsing tie it with string a couple of inches from
the baby, 1 apart. Cut the cord between the strings. Stop any bleeding.

Placenta Delivery
Placenta needs to separate off the uterus wall
on its own usually happens with a gush of
blood. Slowly apply traction, twisting as it comes
out.
Massage mothers uterus to make it contract
hard enough so it is uncomfortable for the
mother. 10 min or so until bleeding slows.
Repeat if bleeding begins baby nursing also
does this also. Have baby nurse right way.

Care of Mother and Child

Rest
Lots of fluids
Nurse
Keep warm

Delivery Complications
Umbilical cord around the neck gentle
slip the cord over the head. If you need to
cut it delivery can not be delayed.
Prolapsed cord umbilical slips down into
the vagina. Hips up Knees to chest
stop pushing -transport. If delayed try to
move cord (with care)
Breech- feet or buttocks present first.
Transport. 98% of births are head first.

Gender Specific Emergencies

Be straight forward, respectful and non
judgmental. Use proper Medical
terminology
Avoid jokes or slang
A member of the pt.s sex should be
present for the exam especially with
minors.

Male Genitalia
Penis- contains a canal the urethra that
urine from the bladder and sperm form
the testes is expelled.
Scrotum- pouch like, testes glands within
it sperm and testosterone production.
Epididymis organ that lies behind the
testes sperm matures and stored.
Duct Deferens- transportation of sperm

Male Specific Emegencies

Inguinal Hernia (possible in women, 10x more men)
part of intestine protrudes into the abd wall
or scrotum.
Lump in groin area, sharp steady pain.
If intestines blocked abd problems
Reduce: lye on back with head lower than
abd. Apply moderate steady pressure up
to 10 min. Ice first if swollen.
If intestinal blockage evac. NPO

Epididymis

Pain in scrotum w/ possible fever.

Pain comes on slowly over several days
Support with jock strap
Antibiotics needed evac
Ibuprofen for fever and swelling

Torsion of the Testis

Twisting of the testis within the scrotum
Does not need a violent action
Vas deference and blood vessels become
twisted decreasing blood supply
Sudden and intensely painful, red and swollen
(can come on slowly though)
Cool compresses and pain meds. Jock strap to
elevate scrotum. Evac
Try to lift gently and rotate outward if doesnt
work try opposite (2x) EVAC! w/in 24 hrs.

Female Genitalia

Vagina or birth canal

Cervix: circle of tissue, top of the vagina
Uterus: size of a fist expands with the growing fetus
Ovaries: produce eggs and estrogen and progesterone.
Each month one egg travels down the fallopian tube to
the uterus
Menstrual cycle: monthly release of ova (egg). 28 days
average
Endometrial tissue: lines the uterus changes to prepare
for a fertilized egg. If none it sloughs off expelling 4-6 T.
blood tissue and mucus (first 5 days). Days 6-16
regrows. Ovulation day 14 takes 6.5 days to reach
uterus

Guidelines
Gather information about menstrual and
sexual history. Ask open ended tell me
about your normal menstrual cycle
When was last menstrual period? How
long is her cycle? Is she sexually active?
How long is her cycle? What is normal?
Does she use contraceptives?

Female Specific Emergencies

Abnormal Vaginal Bleeding: usually related to
estrogen and progesterone levels beginning
and ending of reproductive period. If not
excessive cramping not much done in the field.
Seek medical help if continues over months.
Secondary Amenorrhea: absence of
menstruation (after at least one period).
Common in wilderness setting d/t stress. Be
sure to rule out pregnancy.

 Dysmenorrhea: pain in association with menstruation.

Cramping . If normal for pt. things that can help; exercise,
ibuprofen, yoga, back massage, heat.
Premenstrual Syndrome (PMS): cluster of symptoms.
Decrease stress, good diet, exercise.
Urinary Tract infections: UTI increase frequency of
urination, burning sensation during urination. Can progress to
kidney infection. Drink copious amounts of water. Rest and
clean area. IF to kidney need to Evac.
Vaginal infections: yeast, bacterial. Redness, swelling,
soreness and itching. May have discharge and burning during
urination. OTC (monistat), antibiotics, hydrocortisone cream.
Clean perineal area
Wear cotton underwear and loose outer pants
Drink plenty of fluids

 Pelvic inflammatory Disease (PID) Inflammation of fallopian tubes, ovaries and

uterus. Most often seen in sexually active
women. Pain is diffuse in middle lower abd
which gradually develops. Fever, nausea,
vomiting, abd bloating. May complain if
irregular bleeding. EVAC.

Toxic shock syndrom: bacterial, if

tampon left in long.
High fever, chills, muscle aches, sunburn-like
rash, mucous membranes are beet red.
Remove tampon, drink lots of fluids and seek
medical attention.