Backcountry Medicine

Question 1

For behavioral emergencies, what are six red flags to watch out for as it pertains to altered mental status.

Answer 1

• Verbal or physical threats to harm self or others.
• Unwilling or unable to feed or protect self.
• Delusions or hallucinations that could result in injury to self or others.
• Hx of similar serious event.
• No obvious temporary or treatable cause (STOPEATS).
• Symptoms are getting worse.

Question 2

When is an illness considered serious and high risk?

Answer 2

When a problem fully interferes with critical systems and mental status.

Question 3

Describe a treatment plan for a patient suffering a stroke.

Answer 3

PROP and urgent evacuation.

Question 4

Create a list of red flags to watch out for.

Answer 4

• Change in Mental Status
• Paralysis
• Difficulty Breathing/Swallowing
• Volume Issues (Persistent Vomiting/Diarrhea > 24 hours; Bleeding)
• Blockage
• Persistent Pain > 24 Hours
• Localized Pain
• Generalized Pain in Combo w/Other Red Flags
• Colored/Smelly Discharge
• Possibility of Pregnancy
• Contagious

Question 5

What is cardiogenic shock and how is it different than cardiac arrest?

Answer 5

Cardiogenic Shock = not enough perfusion pressure (see definition above) caused by the heart not pumping properly.

Cardiac Arrest = heart stops pumping.

Question 6

When is an illness considered not serious and low risk?

Answer 6

When the problem does not interfere with critical systems and mental status.

Question 7

Describe the different causes of a stroke.

Answer 7

Bleeding (hemorrhagic).

Blockage (ischemic – clot).

Question 8

For behavioral emergencies, what are nine red flags to watch out for as it pertains to pertinent history.

Answer 8

• Substance abuse.
• Bipolar disorder.
• Schizophrenia
• Eating disorder.
• Major depression.
• Suicide attempts.
• Violent behavior.
• Post Traumatic Stress Disorder.
• Recent medication change (new or discontinued).

Question 9

Aspirin

Answer 9

Acetylsalicylic acid (ASA), is a medication used to treat pain, fever, or inflammation. It falls in the nonsteroidal anti-inflammatory drug (NSAID) class. It is important to note that aspirin suppresses the normal functioning of platelets (a.k.a. blood thinner). Should not be given to trauma patients where bleeding is on the problem or anticipated problem list.

Question 10

Seizure

Answer 10

Uncoordinated electrical activity in the brain.

Question 11

What important factors should the assessment focus on to determine if a problem is serious or not serious?

Answer 11

Is there a critical system problem?

Is the patient’s mental status normal?

Is the patient able to eat/drink and urinate/defecate normally?

Is the patient in significant pain?

Are the symptoms getting better or worse?

Question 12

Stroke

Answer 12

Localized brain ischemia, typically caused by a clot or bleed, that results in partial loss of brain function. Capable of causing elevated intracranial pressure.

Question 13

Describe the treatment plan for a patient suffering from hypoglycemia.

Answer 13

PROP

Sugar by mouth – after good response encourage complex carbs to prevent sugar spike/long term maintenance.

Urgent evac if no response.

Question 14

Cardiogenic Shock

Answer 14

Shock caused by inadequate function of the heart, or pump failure.

Question 15

How is a seizure best managed?

Answer 15

Protect patient from injury, treat the cause, evacuation, and PROP

Question 16

Is hyponatremia truly a heat related problem? Why or why not?

Answer 16

While hyponatremia is common in endurance races that may be in warm weather, it is not a heat related problem. It is a dilution problem caused by excessive sweating/not replacing electrolytes or drinking too much water, which can occur in any type of weather.

Question 17

What precautions can we take in the field when a diabetic is in the group?

Answer 17

Frequent blood sugar monitoring.

Have food and water easily accessible.

Patient should have backup insulin.

Question 18

What is the treatment for hyponatremia?

Answer 18

Rest, restrict fluids unless there is evidence of dehydration (pendulum effect), evacuate if not getting better. Urgent evacuation if getting worse.

Question 19

Hyponatremia

Answer 19

low blood salts

Question 20

What is diabetes?

Answer 20

The inability to produce the appropriate amount of insulin in response to rising blood sugar levels in the blood.

Question 21

When is cardiogenic shock considered to be a serious problem requiring evacuation? Hint: what is the ideal treatment?

Answer 21

Always. The patient needs a hospital!

Question 22

What is a seizure?

Answer 22

An electrical disturbance in the brain. It’s a symptom of a problem causing the electrical disturbance.

Question 23

How is hyponatremia identified?

Answer 23

Key indicator is found in patient’s history…excessive fluid intake or excessive sweating/not replacing electrolytes. S/Sx can look like several other problems:

• altered mental status
• slow to respond to questions/directions (a.k.a. slow mentation)
• lethargic
• agitated
• nausea
• headache
• weakness
• seizures
• tremors
• urine output can be near normal or a lot

Question 24

Describe appropriate treatments for someone having mental health crisis.

Answer 24

• Provide reassurance and protection.
• Be vigilant for any threat of violence.
• Do not try to talk patients out of their symptoms.
• Protect self, crew, and patient if possible.
• Call for help.
• Initiate evacuation if serious signs and symptoms develop.

Question 25

Hypoglycemia

Answer 25

low blood sugar

Question 26

When assessing for risk of suicide or harm, what questions should a rescuer ask?

Answer 26

* Are you thinking about suicide? * Do you have a plan? * Do you know how you would do it? * When was the last time you thought about suicide?

Question 27

What two tools are helpful when engaging with someone experiencing a behavioral issue?

Answer 27

Compassion and active listening.

Question 28

Why is it important not to administer insulin or have a patient administer insulin to themselves who is not awake and oriented/reliable?

Answer 28

Insulin can drastically reduce blood sugar to life threatening or fatal levels if dosage is improperly calculated.

Question 29

What is hyponatremia?

Answer 29

A condition in which the body has insufficient sodium and other salts, usually because of excess sweating or excessive water intake without food.

Question 30

List some common signs/symptoms than can occur with a stroke.

Answer 30

* Trouble with balance. * Blurry vision or blind in one or both eyes. * Facial drooping. * Arm weakness – one sided. * Speech deficit – slurred speech, gibberish.

Question 31

What are the two mechanisms for cardiogenic shock? How do you treat each?

Answer 31

**Coronary Heart Disease** – clogged artery resulting in not enough oxygenated blood being delivered to the heart (ischemia) or heart not pumping properly (irregular rhythm). **Trauma** – bruised heart or blood or fluid fills the space around the heart squeezing it not allowing it to pump properly.

Question 32

List 10 warning signs of suicide or harm?

Answer 32

* Threatening to hurt or kill oneself. * Seeking access to means to hurt or kill oneself. * Talking or writing about death, dying, or suicide. * Feeling hopeless. * Acting recklessly or engaging in risky activities. * Increased use of alcohol or drugs. * Withdrawing from family, friends, or society. * Appearing agitated or angry. * Having a dramatic change in mood. * Showing signs of reduced self-care (i.e., odor, soiled clothing).

Question 33

Describe how a patient suffering from hypoglycemia may present.

Answer 33

* irritability & fatigue * altered mental status * above normal heart rate * sweats * VPU on AVPU

Question 34

Hyperglycemia

Answer 34

high blood sugar

Question 35

Diabetes

Answer 35

A disease resulting in the inability to produce the appropriate amount of insulin in response to rising blood sugar levels in the blood.