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WFR Course Study Guide Flashcards

1
Q

What considerations should you make when evaluating a scene?

A

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

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2
Q

What are the 5 components of the primary assessment?

A

M - Massive hemorrhage
A - Airway (with C-spine precautions)
R - Respiration
C - CIrculation
H - Hypothermia/Hyperthermia or Hike vs. Helicopter

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3
Q

What is the top priority for CPR?

A

Circulation first - emphasizing the importance of early, uninterrupted chest compressions

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4
Q

Why do we place patients in the recovery position?

A

Reduces risk of aspiration - tongue won’t occlude airway, drainage of vomit

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5
Q

If you’re giving rescue breaths, how can you tell if you’re doing it effectively?

A

Adequate chest rise and fall

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6
Q

How do you assess circulation?

A

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

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7
Q

What three things are assessed in the Glasgow Coma Scale?

A

Eye-opening Response
Verbal Response
Motor Response

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8
Q

What are the six components of the secondary survey?

A

S - Symptoms/Subjective
A - Allergies
M - Medicine
P - Prior medical history
L - Last oral intake
E - Events leading up to illness/injury

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9
Q

What does it mean to say someone is Alert and Oriented x 4 (A&O x 4)?

A

Do they know person, place, time, situation
- their name
- where they are
- what time it is or day
- what happened

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10
Q

What are some of the ways we characterize pain?

A

C - Character (type of pain)
O - Onset
L - Location
D - Duration
E - Exacerbation
R - Relief
R - Radiation

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11
Q

What do you include in each of the 4 parts of the SOAP note?

A

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

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12
Q

What are at least five conditions that always need evacuation?

A

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

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13
Q

What is meant by the term “shock”?

A

Inadequate delivery of oxygenated blood (perfusion) to the tissues and organs of the body

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14
Q

What are the three types of shock?

A

Cardiogenic
Hypovolemic
Vasogenic

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15
Q

What is cardiogenic shock?

A

failure of the heart to pump blood effectively throughout the body. Heart attack.

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16
Q

What is hypovolemic shock?

A

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

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17
Q

What is vasogenic shock?

A

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.

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18
Q

How can you tell if someone may be in shock?

A

Look for causes
Changes in vital signs
Rapid/weak pulse
Rapid/shallow breathing
Pale, cool, clammy skin
Anxiety or restlessness
Nausea, thirst

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19
Q

How can you use the radial pulse and mental status to know which stage of shock someone may be in?

A

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

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20
Q

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?

A

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

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21
Q

When should you evacuate someone who’s in shock?

A

When their condition does not improve

Worsening shock, deterioration of mental status, circulatory system collapsing (blood pressure falling or pulse becoming weak)

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22
Q

What is another name for a heart attack?

A

acute coronary syndrome

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23
Q

What are the signs of acute coronary syndrome?

Is the pain always directly above the heart?

A

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

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24
Q

How do you treat a heart attack in the wilderness?

A

Stop all activity - don’t hike out
Give adult-strength aspirin
Give nitroglycerin if prescribed
Evacuate

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25
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
26
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
27
What are the signs that someone has experienced syncope?
Loss of consciousness/fainting Preceded by feelings of warmth, sweating, lightheadedness Most people recover quickly
28
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
29
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
30
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
31
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
32
How do you treat the flu in the wilderness?
hydration and hygiene rest and patience pain medication decongestants and anti-cough med bland diet
33
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
34
What are the signs that someone is choking?
sudden shortness of breath or cough squeaky sounds blue color around lips
35
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
36
What should you do if the first dose of an epi pen does not improve their condition?
give a second dose
37
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.
38
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
39
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
40
When should an asthma patient be evacuated?
if no improvement with Albuterol
41
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
42
Who is at risk for pulmonary embolism?
pregnant recent surgery long travel smoking oral contraceptives high altitudes
43
What can you give a patient who you suspect might have a pulmonary embolism?
aspirin
44
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
45
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
46
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
47
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
48
What are the signs of High Altitude Cerebral Edema?
Severe Acute Mountain Sickness and Ataxia (stumbling around) or severe altered level of consiousness
49
What outdoor activities are generally safe for people who have seizures?
wilderness activities, trek, go to high altitude
50
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
51
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.
52
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.
53
When should seizure victims be evacuated?
First-time seizure or unknown origin. Multiple seizures in a short time period.
54
What are the signs of hypoglycemia?
Rapid onset. Weak, disoriented, irritable Rapid Heart Rate Skin: Pale, Cool, Clammy NO breath odor changes
55
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
56
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
57
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
58
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
59
Why is it important to note the time that the stroke symptoms started?
Helps health care providers determine the best treatment for each person
60
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
61
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
62
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
63
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
64
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
65
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
66
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
67
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
68
What are the three components of the focused spine assessment?
1. Is the patient Reliable? 2. Do they have normal circulation, sensation, and motion in all 4 extremities? 3. No spine pain tenderness when spine is palpated.
69
What is a "reliable" patient?
Sober, not distracted, able to focus, A&Ox3 or 4
70
How do you test circulation, sensation, and motion?
Warm, pink digits, radial pulse No numbness, tingling, or unusual feelings Motion in all four extremities
71
How can you test for spine tenderness?
Palpate along entire spine
72
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
73
What are two ways to stabilize the spine?
Improvise a device Use hands on head
74
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
75
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
76
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
77
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
78
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
79
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.
80
What materials can you use to improvise a shield against a patient's blood?
patient's own gear backpacks plastic bags
81
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
82
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
83
What is the best way to prevent wound infection?
high pressure irrigation with cleanest water available for a long time
84
Why should you always keep wounds covered and moist?
it helps prevent scabbing/scarring
85
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
86
How do you recognize an infected wound?
Redness/swelling, heat/pain Red streaks, fever/chills, swollen lymph nodes
87
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
88
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
89
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
90
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.
91
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
92
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
93
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
94
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
95
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
96
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
97
What's the general treatment for athletic injuries (sprains)?
R - rest, I - Ice, C - Compression, E - Elevation
98
When would you evacuate an athletic injury?
Based on practical considerations Continued pain Injuries that don't heal Inability to travel
99
What are some risk factors for heat illness?
Muscle breakdown Multiorgan dysfunction Cell death Shock Heart arrhythmias
100
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
101
What are the signs of heat syncope?
prolonged standing in a hot environment that leads to fainting sudden episode of fainting or dizziness
102
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
103
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
104
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
105
How can you acclimatize beforehand if you're traveling to a hot destination?
Spend a week or more acclimatizing Frequent breaks Monitoring Encourage hydration ______________

First Aid/CPR/AED/First Responder (5 decks)

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