Wilderness medicine

Question 1

What to do when an authority arrives?

Answer 1

LISTEN TO THEM

let them do the protocols

Question 2

Situational awareness

Answer 2

need to know your limitations

Question 3

Care is delayed by

Answer 3

situation
distance
environment

Question 4

wasp, hornet, and honeybee anaphylaxis

Answer 4

3 different types of venoms

but they cross react

Question 5

someone gets a bee sting and then loses consciousness, what do you do? Why was there a delay?

Answer 5

15-30 min before you get an anaphylactic event

get epinephrine

Question 6

anaphyatic reaction, what to administer

Answer 6

epinephrine

Question 7

what happens during anaphyalxis

Answer 7

hypotension, bradycardia, decreased respiration

Question 8

what side is the needle of an epipen?

Answer 8

orange side

Question 9

What is the adult vs child dose?

Answer 9

0.15mg for 33-66 pounds

0.3mg for 66+ to 999 pounds

Question 10

where does the epipen go

Answer 10

anterolateral thigh THROW the clothes

Question 11

If you are allergic to bees, what can you do?

Answer 11

Check allergies for specific species of bees

Question 12

How much more affinity is CO then O2 to hemoglobin?

Answer 12

210 times

CANNOT be seen with pulse ox

Question 13

treatment of CO poisoning

Answer 13

hyperbaric oxygen chamber

Question 14

When do you treat pH of lactic acidosis

Answer 14

< 7.15 pH

Question 15

Heat illness, what you see

Answer 15

Heat edema
Heat syncope
Heat cramps
Heat exhaustion
Heat stroke

as you go down, the list, it becomes worse

Question 16

Heat edema

Answer 16

legs swell because there is no core body temperature change

just rest, cooling of skin, and rehydration

Question 17

Heat syncope

Answer 17

BP drops but temperature is ok

hypernatremic even if normal sodium

need fluids IV or oral, can send home after stabilizing

Question 18

Heat cramps

Answer 18

muscles are not getting enough O2, caused by hyponatremia

Question 19

If you take less than ____ your body can STILL absorb it

Answer 19

6%, meaning that Gatorade allows you to absorb the most carbs without it just sitting in your stomach

sometimes you can cut to 3%

Question 20

Heat exhaustion

Answer 20

need to use rectal thermometers for core temperature

104F

BP cannot stay up
hypernatremic (too much water loss) OR hyponatremic (water gain)

Question 21

why is water alone in extreme exhaustion not ok?

Answer 21

Can lead to hyponatremia

need electrolytes

Question 22

Heat stroke

Answer 22

Body cannot pump blood

liver kidneys, vascular endothelium, and nerves

CV collapse d/t not enough fluid

Question 23

Sepsis

Answer 23

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

Question 24

thyroid storm

Answer 24

T4 and T3
Temp elevated
shaking
N/V/D anxious
mortality is 75% if untreate

Question 25

Serotonin syndrome

Answer 25

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

Question 26

tumor lysis syndrome

Answer 26

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

Question 27

How to tell if someone is clinically heat stroke

Answer 27

HA, dizziness, confusion brusing, petechia, skin is hot flush and dry

Question 28

In heat stroke, what needs to happen

Answer 28

EMS CBC, PT/PTT CMP Creatinine kinase EKG CXR rapid cool

Question 29

fastest way to cool down

Answer 29

evaporation with fan + ice cold towels needs to go to 102F cool brain with caps

Question 30

What IV fluid do you use for heat stroke?

Answer 30

IV fluids with NS or LR aggressive

Question 31

What is trench foot

Answer 31

seen in homeless washing dishes sleeping under a bridge can't walk warm feet with baths pain never resolved NOT freezing

Question 32

Frost bite

Answer 32

You amputate in july what is frostbite in january

Question 33

1st, 2nd, and 3rd degree frostbite

Answer 33

1st = red 2nd = purple + 4th = necrotic let third one go as long as it can before cutting it off

Question 34

pain with frostbite

Answer 34

happens with rewarming

Question 35

treatment of rewarming for frostbite

Answer 35

rewarm continuously

Question 36

what is mild, moderate, severe, and dire hypothermia

Answer 36

consious + shivering (only one can you self recover) decreased cognition and

Question 37

hypothermia treatment outpatient

Answer 37

insulate the ground strip down (you and them) and cuddle in a sleeping bag ABCs warm liquids

Question 38

what is the rescue method?

Answer 38

lay them down keep them laying down

Question 39

ER workup for hypothermia

Answer 39

CBC CMP TSH Cortisol PT/PTT Lactic acid rewarm, IV fluids, horizontal, airway is needed

Question 40

when can you do one defibrillation

Answer 40

core temp less than 30 degrees C (86 F) only ONE d fib