WFR Course Study Guide Flashcards
(170 cards)
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
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
3
Q
What is the top priority for CPR?
A
Circulation first - emphasizing the importance of early, uninterrupted chest compressions
4
Q
Why do we place patients in the recovery position?
A
Reduces risk of aspiration - tongue won’t occlude airway, drainage of vomit
5
Q
If you’re giving rescue breaths, how can you tell if you’re doing it effectively?
A
Adequate chest rise and fall
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
7
Q
What three things are assessed in the Glasgow Coma Scale?
A
Eye-opening Response
Verbal Response
Motor Response
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
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
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
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
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
13
Q
What is meant by the term “shock”?
A
Inadequate delivery of oxygenated blood (perfusion) to the tissues and organs of the body
14
Q
What are the three types of shock?
A
Cardiogenic
Hypovolemic
Vasogenic
15
Q
What is cardiogenic shock?
A
failure of the heart to pump blood effectively throughout the body. Heart attack.
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
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.
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
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
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
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)
22
Q
What is another name for a heart attack?
A
acute coronary syndrome
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
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
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
______________
106
What are the symptoms of mild hypothermia? Severe hypothermia?
Mild - shivering, numb skin with goose bumps, minor impairment of muscular performance - stiff and clumsy fingers, poor decisions, confused and sluggish thinking
Severe - Shivering may cease, incoherence, irrational behavior, heart and respiratory rate and blood pressure fall, muscle rigidity, pulse may be undetectable
107
What should you pay particular attention to in a hypothermic victim?
mental state - what is normal state and when did they start acting strange
108
Why should you check the pulse in a cold victim over a long period of time?
decreased basal metabolic rate can allow victim to survive for a long time without a detectable pulse
109
How do you treat hypothermia?
completely undress and re-dress in dry clothes and blankets
cover head and neck
give carb rich beverages and foods
place patient in sleeping bag with pad underneath; hold warm water bottle
110
What is after-drop?
Why should you never submerge even mildly hypothermic people in warm water?
a decrease in the core temperature if the extremities are rapidly rewarmed
because as the cooled blood returns to the core, it decreases the overall body temp and can cause the heart to stop
111
How does cold water actually kill people, in most cases?
immersion syndrome where reflex reactions of uncontrolled gasping and massively increase blood pressure cause cardiac arrest and loss of control of bodily functions needed for swimming
112
What is the most important consideration to make when deciding whether to treat
frostbite in the field?
whether or not the tissue is likely to be refrozen again. If so, do not treat in the field but wait.
113
How can frostbitten tissue be rewarmed?
place in warm water/hot tub
don't allow refreezing
don't rub
not next to a fire
114
What causes trench foot? Is it painful?
prolonged exposure to water or sweat
not usually
115
How can you prevent trench foot?
wear dry, loose-fitting shoes
don't submerge in water
rewarm at room temp
elevate legs
don't massage
116
What are some things you can do to protect yourself if you're caught outside in a lightning storm?
get inside a building or vehicle
avoid open fields, top of a hill, tall isolated trees or objects
stay near shorter clump of trees
avoid staying in a tight group
set up camp in a valley or ravine
stay away from water or wet items
117
Why should you spread out far away from other people in lightning?
in order to avoid the current traveling between group members
118
How do you treat lightning injuries? Who should you treat first if there are multiple
people injured?
wait until immediate danger has passed
cool burning area; remove hot jewelry or clothing
perform CPR
dress wounds/burns; immobilize fractures or spine
reverse triage: prioritize patients with no pulse or breathing
119
What are some typical immediate effects of lightning strikes?
heart asystole
respiratory arrest
broken bones and muscle pains
seizures
confusion
Lightenberg ferning
120
Why are flash floods so deadly?
the sudden onset leaves little time for people to prepare or evacuate; the storm could be occurring a long ways away
121
What should you do if a flash flood is nearby?
scramble to higher ground
do not drive through a flooded area
grab a stick; watch for displaced animals; point feet downstream; go over obstacles
122
What is the biggest factor that leads to altitude illness?
the partial pressure of oxygen which decreases as altitude increases leading to not enough pressure to push oxygen into the bloodstream
123
How do you recognize and treat acute mountain sickness?
recent gain in altitude with presence of a headache and at least one of:
-dizziness, fatigue, nausea, insomnia
Stop ascending until symptoms resolve.
If no improvement, descend.
124
What is the primary clue that someone may have developed High Altitude Cerebral
Edema (HACE)?
Severe mental symptoms or ataxia as well as symptoms of acute mountain sickness
125
What are some signs of High Altitude Pulmonary Edema? What should you do about it?
symptoms of acute mountain sickness plus at least two of the following:
-shortness of breath at rest
-cough
-weakness or decreased exercise performance
-chest tightness
-crackles or wheezing
-tachypnea
-tachycardia
Descend
Supplemental oxygen
126
How can you prevent altitude illness?
Gradually ascend, no more than 2,000'/24hrs
Acetazolamide
Dexamethason
Ginko??
127
Why is drowning silent?
a small amount of water hits the trachea causing muscle spasms that seals the airway and prevents passage of air and sound
128
Why should you try to approach a drowning victim from behind?
so they victim doesn't grab the resuer and submerge them as well
129
Once you have a drowning victim back on land, what's the first thing you should do?
5 rescue breaths
130
What should you do if someone in your group comes down with the flu?
Let it run its course while getting plenty of rest.
Hydration.
NSAIDs or pain medication.
Camp hygiene.
131
What are some signs that you would be concerned about with a sore throat?
Fever persists for more than 48 hours or is greater than 104F.
Patient develops stiff neck, sudden or severe headache, or difficulty breathing.
SOB, decreased exercise tolerance, fatigue.
Unable to tolerate oral fluids for more than 48 hours.
132
Someone on your trip has had an upset stomach and diarrhea for a few days. What would be some signs that they should be evacuated?
Bloody or coffee-ground vomit
Bloody diarrhea
Unable to hydrate
Persistent diarrhea despite treatment
Spiking fever
Unable to tolerate oral fluids for more than 48 hours.
133
What are the symptoms of kidney stones? What should you do if you suspect someone has this?
Excruciating pain that comes and goes with increasing intensity
Pain radiates to lower abdomen or groin
Pale, sweaty, nauseated, writhing in pain
Worse with urination
Possible blood in urine
No chills or fever
Hydrate with lots of water
Pain medication
Evacuate if pain is greater than 48 hours or cannot urinate
134
What are the symptoms of appendicitis?
Pain behind the umbilicus developing over 1-2 days
Pain shifts to lower right quadrant
Anorexia
Nausea
Vomiting
Possible fever and elevated pulse
Skin over appendix is very sensitive
Legs tucked into the abdomen
Pain even with slight movement
135
What are the symptoms of a mild allergic reaction? A severe one? What would you do
to treat either of these?
Local swelling, runny nose, sneezing, swollen eyes, flushed itchy skin, hives or welts, mild or no breathing difficulty
Flushed and itchy skin, swollen face, lips and tongue, respiratory distress, shock
Remove allergen from patient or patient from environment
Oral antihistamines
Topical glucocorticoids
Hydration
Monitor for increased breathing difficulty
Inject epinephrine
Watch for second reaction
Evacuate
136
What type of outdoor activities are ok for women who are pregnant? What activities
should be avoided?
Generally all
Avoid hyperthermia, dehydration, maternal trauma, those at high risk for falling or abdominal trauma, scuba diving
137
Why should pregnant women get up and move frequently on long flights?
Because there is a decrease venous stasis during long periods of immobility
138
You're spending the night at a campsite with your friends. One of them is six months pregnant, and throughout the evening, she starts to have abdominal pain. What should she do? Under what conditions would you advise her to leave and go to the hospital?
Persistent or recurrent abdominal pain should be evacuated
Rest and hydrate
In dire circumstances, give antibiotics and ibuprofen
139
What should you do and not do when assisting with a delivery outside of the hospital?
Stabilize mother first
Have mother lay on her side
Supplement with oxygen and IV if available
No oral intake
Don't encourage pushing
Do not pull
Flex mother's thighs to chest
Clear infant's mouth and nose upon delivery
Rub feet to stimulate breathing or gentle CPR
140
What are the signs of a possible ectopic pregnancy? What should you specifically ask?
Sharp lower abdominal pain
Sometimes vaginal bleeding
Pregnancy test can show
Evacuate
Ask about last menstrual period
141
When should someone with a urinary tract infection (UTI) be evacuated?
Pain is in lower back (kidneys)
Symptoms last greater than 48 hours despite antibiotics
142
What should you do if someone develops testicular torsion?
Have the patient attempt to untwist
143
How should you examine the eyes?
Do not rub
Pull lower lid down and have patient look up
Flip the upper lid over a small stick or cotton swab and have patient look down
144
How should you remove small foreign bodies from the eyes? Large foreign bodies?
Small - remove gently by irrigating with clean water; if can't, then close the eye with a bandage and evacuate
Large - leave in place. Stabilize with gauze, cover and protect. Consider bandaging both eyes. Evacuate.
145
Someone has a cut near their eye. How do you decide if they should be evacuated for
treatment?
May not need to evacuate if cut does not cut through full thickness of eyelid; does not include lid margins; nothing penetrated the eye
Evacuate if any of the above
146
One of your campers has been complaining of eye irritation all day. How do you decide
if he should be evacuated?
Use antibiotic drops if have. Evacuate if no improvement in 24 hours.
147
What kind of bleeding in the eye does not need to be evacuated (what does it look like?) What kind of bleeding in the eye should be evacuated right away?
Bleeding in the white of the eye - due to hard coughing or increasing blood pressure. Needs to be evacuated only if it came from a direct blow.
Collection of blood in the anterior chamber of the eye- shows up in iris and may disappear when lying flat. Needs evacuation.
148
What is snow blindness? What can you do to devise goggles to prevent this?
Sunburn on the surface of the eyes.
Sunglasses, glacier glasses; make emergency goggles by cutting horizontal slits in piece of duct tape folded back onto itself.
149
How can you treat lost fillings, crowns, and chipped teeth in the backcountry?
Rinse mouth to remove debris
Fill hole with temporary filling material
150
What should you do if someone's tooth is knocked out?
Put tooth back in its socket and hold with steady pressure
Don't scrub or let dry out
Place in save-a-tooth solution, coconut water, milk, saliva but replace back in mouth within 30 minutes
See dentist
151
What are the three WFR priorities when it comes to ingested poisonings?
Call poison control center
Consider inducing vomiting
Evacuate
152
When should you induce vomiting? When shouldn't you?
Do it if tried early
Do not if patient has a seizure disorder or altered mental status or obstructed airway
Do not for ingested corrosive chemicals or petroleum products
153
What can you give a poisoned patient from the medical kit?
Charcoal
154
What common things in the outdoors produce carbon monoxide?
cars, portable stoves, lanterns, heaters
155
What are the symptoms of carbon monoxide poisoning?
light headedness
headache
weakness
nausea
vomiting
confusion
lethargy
coma
seizures
cherry red coloring of the skin (after death)
156
How can you deter a grizzly bear attack? What should you do once it's attacking?
line up side by side and raise your arms
make the group appear as one large, slow-moving person
yell "hey bear" or other things
Be prepared with bear spray
If attacked, do not look into the eyes
Do not act aggressively
Stand your ground, but be submissive
Get into fetal position with your head and neck protected
Protect face
157
What should you do if a black bear attacks?
Tell and throw things, and act aggressively
Fight and kick
158
What should you do if a mountain lion attacks?
Scare off with aggressive behavior
Face it, talk loudly, make yourself appear as a threat
Don't turn and run away
Rocks/sticks/fists
159
What are the symptoms of venomous poisoning?
Swelling, pain, tingling, metallic taste, fevers/chills, nausea/vomiting, blurred vision, muscle tremors
160
What should you do if someone is bitten by a snake? What shouldn't you do?
Lay or sit the person down with the bite below the level of the heart
Stay calm and still
wash the wound with soapy water
Cover bite with clean, dry dressing
call for EMS
Don't use venom extractors
Don't apply ice
Don't try to catch or kill a snake
Don't use aspirin
Don't cut or suck wound
Don't use a tourniquet
161
Do most scorpion stings need to be evacuated? What's the exception?
No
Just for the bark scorpion in Arizona and New Mexico
162
How should you remove ticks?
fingers or tweezers to grab the tick as close to the skin surface and pull straight upward with steady, even pressure
163
What types of animal bites should you always evacuate for rabies prophylaxis?
Raccoons, bats, skunks, and dogs
164
What is "scope of practice" and "standard of care?" How can you clarify your role with these in the outdoors?
Scope of practice: the care a provider can provide
Standard of care: how care is measured, determined by the level of training and protocols under which you practice
165
Why is it important to document what you've done on a SOAP note?
serves as communication between medical care providers
Invaluable if the level of care is challenged in a legal process, as memory is limited
166
What is the difference between informed and implied consent?
Informed: ongoing and throughout care; reliable patient agrees to treatment after being informed of the risks and benefits
Implied: an unreliable patient would want help during an emergency; applies to minors whose parents are not available
167
What is abandonment in the legal context?
stopping of care too soon
transferring the patient to someone who is not able to provide the care the patient needs
168
What is your role with medication administration as a WFR?
should not be making decisions about whether a patient should or should not take prescription medications
may assist participants in the administration
can offer over-the-counter meds for adults to make own decision
Know epinephrine laws
169
What are some examples of how the Good Samaritan Law can fail to apply?
-GS caused the emergency
-not acting in good faith
-is compensated for help
-committed gross negligence
--causing drastic physical harm
-has a preexisting duty of care
170
What should you do to clarify jurisdiction if you own an outdoor-related company or
service?
should be expressly stated in the contract
Check malpractice insurance
