Wilderness medicine Flashcards
What to do when an authority arrives?
LISTEN TO THEM
let them do the protocols
Situational awareness
need to know your limitations
Care is delayed by
situation
distance
environment
wasp, hornet, and honeybee anaphylaxis
3 different types of venoms
but they cross react
someone gets a bee sting and then loses consciousness, what do you do? Why was there a delay?
15-30 min before you get an anaphylactic event
get epinephrine
anaphyatic reaction, what to administer
epinephrine
what happens during anaphyalxis
hypotension, bradycardia, decreased respiration
what side is the needle of an epipen?
orange side
What is the adult vs child dose?
0.15mg for 33-66 pounds
0.3mg for 66+ to 999 pounds
where does the epipen go
anterolateral thigh THROW the clothes
If you are allergic to bees, what can you do?
Check allergies for specific species of bees
How much more affinity is CO then O2 to hemoglobin?
210 times
CANNOT be seen with pulse ox
treatment of CO poisoning
hyperbaric oxygen chamber
When do you treat pH of lactic acidosis
< 7.15 pH
Heat illness, what you see
Heat edema
Heat syncope
Heat cramps
Heat exhaustion
Heat stroke
as you go down, the list, it becomes worse
Heat edema
legs swell because there is no core body temperature change
just rest, cooling of skin, and rehydration
Heat syncope
BP drops but temperature is ok
hypernatremic even if normal sodium
need fluids IV or oral, can send home after stabilizing
Heat cramps
muscles are not getting enough O2, caused by hyponatremia
If you take less than ____ your body can STILL absorb it
6%, meaning that Gatorade allows you to absorb the most carbs without it just sitting in your stomach
sometimes you can cut to 3%
Heat exhaustion
need to use rectal thermometers for core temperature
104F
BP cannot stay up
hypernatremic (too much water loss) OR hyponatremic (water gain)
why is water alone in extreme exhaustion not ok?
Can lead to hyponatremia
need electrolytes
Heat stroke
Body cannot pump blood
liver kidneys, vascular endothelium, and nerves
CV collapse d/t not enough fluid
Sepsis
Body becomes dysregulated d/t infection
Gram negaitve MC
Body injures itself
Goes into shock
circulatory collapse
Need pressors
SIRS (can quickly begin AB in one hour)
s/s
100.4
tachycardic
RR decreases
WBC can be increased or decreased
Hypotension
thyroid storm
T4 and T3
Temp elevated
shaking
N/V/D anxious
mortality is 75% if untreate
Serotonin syndrome
Taking too many sertonin drugs (SSRIs, SNRIs, saint john’s wort, tramadolol)
looks like a heat illness or thyroid storm
temp increases (even up to 106)
agitation
sweating
tremors
dilated pupils
diarrhea
seizures and muscle breakdown
tumor lysis syndrome
often in tumor patients
ALL
lymphomas
cells in body get destroyed by cancer, or chemo kills the cells and then the waste products cause issues
hyperurcemia, hyperk, hypoPhos, hypocacemia
treated with: hydration, allopurinaol, rasburicase
How to tell if someone is clinically heat stroke
HA, dizziness, confusion
brusing, petechia, skin is hot flush and dry
In heat stroke, what needs to happen
EMS
CBC, PT/PTT
CMP
Creatinine kinase
EKG
CXR
rapid cool
fastest way to cool down
evaporation with fan + ice cold towels
needs to go to 102F
cool brain with caps
What IV fluid do you use for heat stroke?
IV fluids with NS or LR
aggressive
What is trench foot
seen in homeless
washing dishes
sleeping under a bridge
can’t walk
warm feet with baths
pain never resolved
NOT freezing
Frost bite
You amputate in july what is frostbite in january
1st, 2nd, and 3rd degree frostbite
1st = red
2nd = purple +
4th = necrotic
let third one go as long as it can before cutting it off
pain with frostbite
happens with rewarming
treatment of rewarming for frostbite
rewarm continuously
what is mild, moderate, severe, and dire hypothermia
consious + shivering (only one can you self recover)
decreased cognition and
hypothermia treatment outpatient
insulate the ground
strip down (you and them) and cuddle in a sleeping bag
ABCs
warm liquids
what is the rescue method?
lay them down
keep them laying down
ER workup for hypothermia
CBC
CMP
TSH
Cortisol
PT/PTT
Lactic acid
rewarm, IV fluids, horizontal, airway is needed
when can you do one defibrillation
core temp less than 30 degrees C (86 F)
only ONE d fib
