WFR Course Study Guide Flashcards
What considerations should you make when evaluating a scene?
Don’t approach the patient immediately
Make sure the scene is safe
- snow, ice, rocks, fire, animals
Determine how many people are injured and how
- Mechanism of injury or nature of illness
- Ask them if there were others involved
What are the 5 components of the primary assessment?
M - Massive hemorrhage
A - Airway (with C-spine precautions)
R - Respiration
C - CIrculation
H - Hypothermia/Hyperthermia or Hike vs. Helicopter
What is the top priority for CPR?
Circulation first - emphasizing the importance of early, uninterrupted chest compressions
Why do we place patients in the recovery position?
Reduces risk of aspiration - tongue won’t occlude airway, drainage of vomit
If you’re giving rescue breaths, how can you tell if you’re doing it effectively?
Adequate chest rise and fall
How do you assess circulation?
Look at skin color and assess capillary refill in all extremities
Check for pulse
Assess neck veins if absent pulses or prolonged capillary refill - distended or flattened
What three things are assessed in the Glasgow Coma Scale?
Eye-opening Response
Verbal Response
Motor Response
What are the six components of the secondary survey?
S - Symptoms/Subjective
A - Allergies
M - Medicine
P - Prior medical history
L - Last oral intake
E - Events leading up to illness/injury
What does it mean to say someone is Alert and Oriented x 4 (A&O x 4)?
Do they know person, place, time, situation
- their name
- where they are
- what time it is or day
- what happened
What are some of the ways we characterize pain?
C - Character (type of pain)
O - Onset
L - Location
D - Duration
E - Exacerbation
R - Relief
R - Radiation
What do you include in each of the 4 parts of the SOAP note?
Demographics of the patient
S - Subjective - patient’s chief complaint or injury
O - Objective - state what you found on your exam of patient, including vitals, injuries, or medical problems
A - Assessment - What you think is wrong
P - Plan - Treatments performed and what you think should be done next
What are at least five conditions that always need evacuation?
suspected spine injury
suspected pelvic injury
open fracture
suspected compartment syndrome
hip or knee dislocation
vascular compromise to an extremity
laceration with tendon or nerve injury
uncertainty of severity of injury
What is meant by the term “shock”?
Inadequate delivery of oxygenated blood (perfusion) to the tissues and organs of the body
What are the three types of shock?
Cardiogenic
Hypovolemic
Vasogenic
What is cardiogenic shock?
failure of the heart to pump blood effectively throughout the body. Heart attack.
What is hypovolemic shock?
Results from low fluid volume within the system and is typically preventable with early recognition and management. Causes include fluid loss such as from bleeding, diarrhea, vomiting, or lack of oral fluid intake
What is vasogenic shock?
loss of tone in the blood vessels and thus increased space and decreased pressure within the system. This type can be caused by a spinal cord injury, severe allergic reaction, or a system-wide infection.
How can you tell if someone may be in shock?
Look for causes
Changes in vital signs
Rapid/weak pulse
Rapid/shallow breathing
Pale, cool, clammy skin
Anxiety or restlessness
Nausea, thirst
How can you use the radial pulse and mental status to know which stage of shock someone may be in?
Early/compensated shock: increased heart rate, stable pulse; anxious/restless mental status
Late/decompensated shock: disorientation, decreased alertness, drowsiness; pulse weakens
Late/irreversible shock: unresponsive mental status; pulse disappears
Treating shock in the wilderness is very difficult, especially without medical training or equipment. However, what are some things you can do to help the patient?
Treat the underlying cause:
-basic life support including CPR
-control bleeding; replace fluids
-spinal immobilization; epinephrine; antibiotics
Lay them flat, elevate legs
Keep them warm
Monitor vital signs
Fluids and oxygen
Evacuate
When should you evacuate someone who’s in shock?
When their condition does not improve
Worsening shock, deterioration of mental status, circulatory system collapsing (blood pressure falling or pulse becoming weak)
What is another name for a heart attack?
acute coronary syndrome
What are the signs of acute coronary syndrome?
Is the pain always directly above the heart?
chest pain or discomfort, tightness or fullness
Pain in one or both arms, jaw, neck, back, stomach
Shortness of breath
Feeling dizzy or lightheaded
Nausea
Sweating
No
How do you treat a heart attack in the wilderness?
Stop all activity - don’t hike out
Give adult-strength aspirin
Give nitroglycerin if prescribed
Evacuate
Someone has a bleeding injury. What should you be regularly testing downstream of the injury?
A pulse - to tell if any arteries are compromised or blood flow cut off
How can you tell the difference between someone who is experiencing sinus tachycardia from a more concerning arrhythmia?
ST: rapid but regular heart rate; appropriate response to physical or emotional stress; has a clear cause
More concerning: heart rate racing starts suddenly when at rest or exertion; no clear cause; fails to resolve with stopping the activity; lightheadedness, palpitations, chest discomfort
What are the signs that someone has experienced syncope?
Loss of consciousness/fainting
Preceded by feelings of warmth, sweating, lightheadedness
Most people recover quickly
What should you do to help someone who has experienced syncope?
Do they always need to be evacuated?
Remove them from dangerous conditions
Monitor breathing and heart rate
Elevate legs
Treat underlying cause: hydration, cooling, stop activities
No
What is the difference between respiratory distress, respiratory failure, and respiratory arrest?
RD: unable to regulate gas exchange, too little oxygen in or too little carbon dioxide out
RF: unable to provide adequate ventilation for body’s requirements
RA: complete stopping of breathing
What do you look for when you’re examining the chest in a primary survey?
check all over exposed chest
check for chest wall movement
establish airway
auscultate, observe, and palpate the chest - listen for differences in sounds between lung compartments; palpate for rib fractures
What are the signs of respiratory distress?
increase in breathing rate
bluish color seen around the mouth, inside of lips, fingernails
grunting sound heard when exhaling
wheezing
retraction of center of chest; sinking look
nose flaring
sweating
forward position; leaning forward, resting on knees
How do you treat the flu in the wilderness?
hydration and hygiene
rest and patience
pain medication
decongestants and anti-cough med
bland diet
When should you think about evacuating a patient with the flu?
fever persists greater than 48h
fever greater than 102
stiff neck, headache, difficulty breathing
pneumonia develops
abdominal pain over 12 h
bloody diarrhea
cannot tolerate fluids more than 48 hrs
sore throat with inability to swallow
red throat with white patches
headache that does not respond to meds
What are the signs that someone is choking?
sudden shortness of breath or cough
squeaky sounds
blue color around lips
What are the signs of anaphylaxis?
skin reaction inc hives and itching
low blood pressure
constriction of airways and swollen tongue or throat
weak rapid pulse
nausea vomiting diarrhea
dizziness/fainting
What should you do if the first dose of an epi pen does not improve their condition?
give a second dose
Why should all anaphylaxis patients go to the hospital, even if they improve?
It’s possible to have a second allergic reaction even after the first has resolved.
How can you recognize when someone is having an asthma attack?
wheezing on exhalation
kneeling forward
chest tightness or weakness
using accessory muscles to breathe
speaking in one to two-word clusters
sleepiness
cyanosis
decreasing breath sounds progressing to absence of sounds
What can you do to help someone having an asthma attack?
calm the patient to slow RR
assist albuterol inhaler use- 2 puffs every 4 hours
get away from an environmental trigger
hydration and rest
When should an asthma patient be evacuated?
if no improvement with Albuterol
How can you distinguish an asthma attack from a panic attack?
Panic attack-
-lack of wheezing
-increased respiratory rate
-dizziness and hand tingling
-sense of suffocation with no cause
Who is at risk for pulmonary embolism?
pregnant
recent surgery
long travel
smoking
oral contraceptives
high altitudes
What can you give a patient who you suspect might have a pulmonary embolism?
aspirin
What do you check for in the primary and secondary assessment of the nervous system?
MARCH
Glasgow Coma Scale
Physical exam: bleeding, bruising, and lacerations on skull or face
- look at eyes, ears, nose, mouth
Strength and sensation of all limbs
You come across someone who’s acting strangely and is not able to answer your questions. Where can you look for clues about their medical conditions or what might be going on?
MARCH
Glasgow Coma Scale
Physical exam: bleeding, bruising, and lacerations on skull or face
- look at eyes, ears, nose, mouth
Strength and sensation of all limbs
What are at least six common causes of altered mental status in the outdoors?
A Allergies / Altitude
E Environment / Epilepsy
I Infection
O Overdose
U Underdose
T Trauma / Toxins
I Insulin (Diabetes)
P Psychological disorders
S Stroke
What are the symptoms of acute mountain sickness?
high rate of ascent and recent gain in altitude
headache
dizziness or lightheadedness
fatigue or weakness
nausea / vomiting / anorexia
insomnia
obese
What are the signs of High Altitude Cerebral Edema?
Severe Acute Mountain Sickness and Ataxia (stumbling around) or severe altered level of consiousness
What outdoor activities are generally safe for people who have seizures?
wilderness activities, trek, go to high altitude
What outdoor activities should be avoided for people who have seizures?
technical climbing and roped travel; something that may have risks to others if you have a seizure
How can you tell the difference between someone who had a seizure and someone who just passed out (syncope)?
Someone who just passes out doesn’t have the post-ictal period (time after a seizure) where they are recovering. Dazed. Last 10 min or more. Those who have a seizure has this period.
What can you do to protect someone who’s having an active seizure?
Protect the patient from injury - move objects out of the way, pad or cradle the head.
Don’t place bite sticks in mouth; don’t force mouth open.
After, open the airway, assess for injuries, place in recovery position.
When should seizure victims be evacuated?
First-time seizure or unknown origin.
Multiple seizures in a short time period.
What are the signs of hypoglycemia?
Rapid onset.
Weak, disoriented, irritable
Rapid Heart Rate
Skin: Pale, Cool, Clammy
NO breath odor changes
What are the signs of hyperglycemia?
Slower onset
Nausea, vomiting, thirst
Increased urine
Skin: warm, pink, dry
Rapid heart rate
Abdominal cramps
Fruity odor to breath
Restless and drunken
What should you do if you’re not sure if a patient is experiencing hyper or hypo glycemia?
Give them sugar either way
Do not give insulin
Watch airway and vital signs
Watch for shock
Give oral fluids if alert
What are the signs of a stroke?
Sudden weakness, visual loss, hearing loss
Difficulty walking, paralysis
Slurred speech
Numbness or weakness on one side of the body
Pins and needles
Sudden severe headache
FAST
What does FAST stand for?
Face - Look for an uneven smile
Arm - Check if one arm is weak
Speech - Listen for slurred speech
Time - Call 911
Why is it important to note the time that the stroke symptoms started?
Helps health care providers determine the best treatment for each person
What should you do and not do for someone experiencing a possible stroke?
Comfort measures
Recovery position
Keep warm
Do not give food
Do not give aspirin
Evacuate
What are the signs of mild brain injury?
any change in level of responsiveness or mental status
short term amnesia
Seeing stars
disoriented, confused, incoherent
headache, vision changes, loss of balance, nausea, vomiting
What are the signs of severe brain injury?
unconscious
heart rate changes or slow pulse; hyperventilation and erratic breathing
unequal pupils
seizures
warm flushed skin
blood or CSF leakage, raccoon sign, bruising behind ears
What does AVPU stand for and how do we use it?
Ongoing (hourly) assessment for brain injuries or altered mental status
A - Awake and alert
V - Not awake but responsive to verbal stimulus
P - Not awake but responsive to pain
U - Not awake and unresponsive
How do you treat brain injuries in the wilderness?
ABCs
Assume cervical spine injury
If vomiting, roll to side
Control scalp bleeding
Keep head elevated
Note level of responsiveness and feeling and movement level, AVPU
Why do we have a low threshold for evacuation of head injuries?
They are difficult to assess and may initially appear benign but become more serious later.
If anyone becomes unresponsive, has vision or balance problems, is irritable, lethargic, nauseous, or vomiting
What are the symptoms of spinal injury?
pain or tenderness on spine
weakness in extremities
loss of sensation
numbness or tingling in hands or feet
incontinence
symptoms of shock
shortness of breath
Why do we use the spinal assessment protocol?
to ensure we immobilize all patients with spinal injury, while excluding those trauma patients with no suspicion of injury
What are the three components of the focused spine assessment?
- Is the patient Reliable?
- Do they have normal circulation, sensation, and motion in all 4 extremities?
- No spine pain tenderness when spine is palpated.
What is a “reliable” patient?
Sober, not distracted, able to focus, A&Ox3 or 4
How do you test circulation, sensation, and motion?
Warm, pink digits, radial pulse
No numbness, tingling, or unusual feelings
Motion in all four extremities
How can you test for spine tenderness?
Palpate along entire spine
When should you immobilize the spine? What if you’re not sure?
If patient fails any step of the focused spine assessment or are uncertain or uncomfortable with your decision
What are two ways to stabilize the spine?
Improvise a device
Use hands on head
What are the evacuation guidelines for spine injuries?
any patient with possible spine injury
any loss of responsiveness even if recovered
headache, irritability or other signs of head injury not improved within 24 hours
Rapid evacuate if:
-changes in mental status
-persistent vomiting or lethargy
-seizures or visual disturbances
-signs of skull fracture
What is meant by a closed vs open wound?
Closed: bruises and hematomas; damage to tissue and blood vessels beneath the epidermis
Open: abrasions, lacerations, punctures
What is the general treatment for closed wounds?
Modified RICE
Rest - rest allows for clots to form but mild movement expedites recovery
Ice - causes blood vessels to constrict
Compression - wrap
Elevation - above the heart to reduce blood flow and swelling
What types of lacerations would require sutures?
if greater than 1 cm especially if:
-on face, hands or a joint
-severs a tendon, ligament or blood vessel
What are the exceptions to the rule that you should leave punctures in place?
unless through the cheek or obstructing airway
unless prevents transport and cannot be stabilized
What is the most common and effective way to control bleeding?
Direct pressure with cleanest material available. Add more material on top of what you are already using. Elevate.
What materials can you use to improvise a shield against a patient’s blood?
patient’s own gear
backpacks
plastic bags
When would it be necessary to tie a tourniquet? What materials can you use to improvise this?
direct pressure isn’t cutting it
cloth, sweatshirt, sticks
What should you do with amputated digits?
transported promptly
wrap in moist dressing and place near ice, not on ice
do not attempt to reattach
What is the best way to prevent wound infection?
high pressure irrigation with cleanest water available for a long time
Why should you always keep wounds covered and moist?
it helps prevent scabbing/scarring
What kinds of wounds should be evacuated?
Open wounds with obvious contamination
Animal bites
Over joint spaces
Infection
Crushed
Lacerations to cosmetic areas
Large lacerations
How do you recognize an infected wound?
Redness/swelling, heat/pain
Red streaks, fever/chills, swollen lymph nodes
How do you measure the extent of a burn? What would be meant by a 5% partial-thickness burn?
Depth: superficial, partial, full
Extent: Rule of Palms = 1% of body area
5 palms worth of skin burned into the epidermis or dermis - red, wet, blistered, blanches
How can you treat most thermal burns?
Removed the source and clothing
Check the airway
Cool the burn using cool water, not ice directly
Assess the depth and extent
Clean and dress; change dressing daily
Why do inhalation burns require immediate evacuation?
they damage the cilia in the upper airways and mucous membranes can be destroyed instantly
Swelling and leaking of fluid into lungs
Unable to expel mucus
Impaired gas exchange
What does SPF actually mean?
guide for length of time the person can be in the sun before expecting to burn. If the normal burn time is 30 minutes, SPF 10 allows 300 minutes before a burn.
What is meant by a closed vs open bone fracture?
Open: skin is broken, exposing bone to contamination
Closed: covered with intact muscle and skin
What are the symptoms of fractures and dislocations?
Pain and point tenderness
Crepitus - grating sound from bones rubbing together
Swelling and discoloration
Deformity
Loss of function or range of motion at a joint
Altered circulation, sensation, and movement
What do you always assess if you suspect a fracture or dislocation?
Check for symmetry
Deformity, swelling, or discoloration
Remove clothing if necessary
Feel for abnormal tenderness or protrusions
Assess circulation, sensation, and movement
-cold, gray extremities
-ask them to move their fingers or toes
-test for reaction to touch or pain
What types of dislocations are generally safe to reduce in the wilderness? Which ones should be immobilized and evacuated?
Reduce if quick transport isn’t available or circulation is impaired, such as shoulder, fingers, and toes
Evacuate more complicated joints such as elbow, knee, wrist, ankle, hip
What are the evacuation guidelines for fractures and dislocations?
Loss of function
Unreduccible dislocation
Any first-time dislocation
Open fractures
Any alteration in circulation, sensation, or motion
What are the signs of athletic injuries (sprains)?
Swelling and discoloration
Pain or tenderness
Instability or loss of range of motion
Inability to bear weight
What’s the general treatment for athletic injuries (sprains)?
R - rest, I - Ice, C - Compression, E - Elevation
When would you evacuate an athletic injury?
Based on practical considerations
Continued pain
Injuries that don’t heal
Inability to travel
What are some risk factors for heat illness?
Muscle breakdown
Multiorgan dysfunction
Cell death
Shock
Heart arrhythmias
What causes heat cramps? How do you treat this?
Salt loss through sweating, imbalance in electrolytes
Replace the salt
Rest
Rehydrate with electrolytes
Stretch, cool, and massage
What are the signs of heat syncope?
prolonged standing in a hot environment that leads to fainting
sudden episode of fainting or dizziness
What is heat exhaustion and heat stroke? What are the signs?
Exhaustion: body becomes overheated and can’t cool itself properly
Symptoms: profuse sweating, fatigue and weakness, dizziness, headache, nausea, rapid heartbeat
Stroke: body temp of 104 or higher
Symptoms: confusion and disorientation, hallucinations, agitation, slurred speech, seizures and coma
Why should you not rely on a lack of sweating to gauge between heat exhaustion or stroke?
skin findings have shown there is likely no difference in skin; can still be sweating in heat stroke, can stop during heat exhaustion
How do you treat heat illness and when should you evacuate the patient?
Move to cool environment
Remove excess clothing
Cool them down
Rehydrate
Evacuate: severe symptoms or not getting better; if further away from medical facilities begin evacuation; if initial treatment was not immediate
How can you acclimatize beforehand if you’re traveling to a hot destination?
Spend a week or more acclimatizing
Frequent breaks
Monitoring
Encourage hydration
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