Unit 4 - Trauma

What are the different types of Shock?

* Cardiogenic
* Obstructive
* Distributive

What are the stages of shock?

* Normal State
* Point of assault
* Compensatory
* Point of decompensation
* Decompensation
* Irreversible

Inadequate tissue perfection is when?

Tissues are not getting enough nutrients and oxygen

Cardiogenic shock includes:

* Arrhythmia
* Heart failure
* Pericardial tamponade
* Valve failure
* Heart attack
* Pericardial synthesis

Obstructive Shock includes (Neapolitan):

* Aortic blockage (strawberry)
* Failure of venous return (chocolate)
* Catheterization (vanilla)

Distributive Shock includes:

* Loss of peripheral vascular resistance
* Septic Shock
* Anaphylactic shock
* Neurogenic shock
* Overwhelming burns
* Anemic/Hypoxia

In Heat Index, what are the four risks?

* Caution
* Extreme Caution
* Danger
* Extreme Danger

Heat cramps are…

* Earliest sign
* An electrolyte imbalance
* Cramps of the abdomen, back, and arms

Heat Exhaustion is…

* Your body’s compensation mechanism failure

Heat Stroke is…

* A form of distributive shock
* Immediate life threat

In order for Heat Emergency Treatment, you have to what?

* Remove Patient from direct sunlight
* Remove pads
* Get PT wet and cold
* Hydrate if they can follow commands

What is Frostnip and what does it include?

* First stage of a cold injury
* Only destroys upper levels
* No sub-dermal freezing
* Incredibly painful

What is Frostbite and what does it include?

* Sub-dermal freezing of tissues
* Widespread cells death
* Delineation of permanent damage
* Similar to a burn (blistering)

What is late Frostbite include?

* Clear delineation of living/death tissues
* Dry Gangrene
* Auto-amputation

What are the three types of Gangrene in late frostbite?

* Cells dry out and break off
* Wet Gangrene: still circulation in it; black gooey mess
* Gas Gangrene: bacteria that has infected the wet gangrene and bubbles (gas bubbles)

Frostbite Treatment:

* Warm affected area (if possible)
* Separate affected digits
* Wrap in sterile, dry gauze
* Transport to trauma center
* Minimize friction
* Do NOT pop blisters

Flags are what?

* Recommend what level of exertion and the precautions that need to be taken by the team to practice/play
* Based on the environment risk, heat, cold, humidity, and wind
* A recommendation of action but coaches still control the practice

A Green Flag means what?

* No restrictions
* Low humidity
* Heat from 65-90F

A Yellow Flag means what?

* Moderate restrictions (Monitor for injury, limit extreme activity to 120 minutes, and for heat, make sure more water is available)
* Heat from 50-68F or 85-95F, in general
* Caution or Extreme Caution on Heat Index
* Rain
* Over 1 hour to frostbite on exposed skin

A Red Flag means what?

* Significant Restrictions (Elevated caution for injury; check in q 20 min; limit extreme activity to 90 min heat; limit exposure activity to 30 min cold; make sure electrolytes available for heat)
* Heat from 85-105F, in general
* Danger on Heat Index
* AQI 50-150
* Rain, cold under 60F or sleet
* At least 30 minutes to frostbite on exposed skin

A Black Flag means what?

* Heavily restricted (Extreme monitoring for injury; check in q 5 min; limit extreme activity to 20 min heat; limit exposure activity to 15 min cold; make sure more electrolytes and active cooling are availale for heat)
* Heat from 105F+
* Extreme Danger on Heat Index
* AQI 150 to 200
* Rain with cold under 45F; sleet; snow
* At least 10 min frostbite on exposed skin

Practice Restricted means what?

* NO outdoor practice
* Only activities in air conditioned / heated spaces. 
* AQI above 200
* Heat index beyond mark
* Less than 5 min to frostbite
* Wind Chill less than 25 F
* Games may be played if accommodations for the match are determined by CIF, League, and/or mutual consent of AD / Coaches. Parents will be informed of PR status and may decide to remove their athlete from practice or play without prejudice.

Primary Intention means what?

When the wound ends can come together (cut and come together)(think when using a surgical blade)

Secondary Intention means what?

* Wound ends can’t communicate with each other; scab materials need to be formed (think lots of jagged edges, think what the spaniards used)
* Significant scarring

Interruptions to wound healing include:

* Anatomical Factors (Joints, high friction, thin areas)
* Concurrent Drug Use (NSAIDs, colchicine, etc)
* Medical Conditions and Diseases (hypoxia, malnutrition, and specific conditions)

High Risk Wounds Include:

* Human bites
* Dog bites
* Cat bites
* Foreign Bodies
* Wounds requiring significant debridement
* Immunocompromised patients
* Poor peripheral circulation
* Compounded mechanism injuries
* No health insurance
* Wounds in an area of social stigma 

Contusions Include:

* Bruises 
* Third spacing of blood and serum (doesn’t create a puddle, spaced out in the third space)
* As it breaks down it changes color (different components of the blood and serum breaking down)
* Not much you can do for them
* Hurts 

Hematoma Includes:

* Confused with bruises
* Bruises are not hematomas
* Pocket of blood that has filled out and can get infected
* If it spreads out and makes a puddle its a bruise 
* Oftentimes there is a giant puddle of blood and bruises around it where it is draining
* Dangerous in terms of pulmonary embolism and things 
* Get it from breaking a major vessel 
* Subdural hematoma: under one of the layers of the brain you have a hematoma where the brain eventually gets squished out
* Bone breaks can cause hematomas 

Abrasions Include:

*  Can’t do a lot for them just debridements; make sure there’s nothing in them
* Non Stick dressing if needed

Lacerations Include:

* Cuts that do secondary intention (the cut ends don’t meet up perfectly)
* Some parts might be clean enough that parts are primary intention 
* Rough gouge cuts 

Incisions Includes:

* Primary intention 
* I.e. paper cuts/ surgery 
* Some surgeries have blunt force resection which have secondary intention where they do a cross stitch to force the edges to go together 
* Major abdominal surgeries 

Avulsions Include:

Any time there is a flap of flesh created

Degloving Injuries Include:

* Something constricts at some point around an arm, toe, leg finger, ect.(anything that protrudes out of the body) And cuts in due to swelling and stress strips off all the tissue and rips all the flesh and everything off of the bones 
* Creates a giant scar tissue 
* Preventing degloving injuries
* If someone has an injury to their hand, crushed, puts their hand into a door, ect. the first thing you need to do is take off the watches, bracelets, rings, ect.  Off before the swelling occurs.  

Penetrations Include:

* Impaled object 
* All penetrations are punctures but not all punctures are penetrations 
* When we come across something we leave it in; never take it out 
* UNLESS it is blocking the airway 
* Never remove an object that is in someone 

Amputations Include:

* Was it connected to the body (yes) is it no longer connected to the body (yes) it’s an amputation 

Sprain Includes:

* Grade 1 strain: small tears; stable (can bleed if they are really bad)
* Grade 2 strain: Larger tear, some laxity, endpoint (If bleeding and bruising normally this one)
* Grade 3 sprain: Complete tear, laxity, no endpoint (require surgical repair)

Strain Includes:

* Grade 1 (mild) - tear of a few muscle fibers with minor swelling and discomfort. Minimal to no strength loss (at or less than ⅘)
* Grade 2 (moderate) - many micro tears leading to greater damage with loss of contractile strength (⅖ or less). Minor to widespread swelling and pain 
* Grade 3 (severe) - tear across the entire cross section of the muscle or tendon resulting near complete loss of function (less than ⅖)

Fractures Include:

Any crack or break in the bone (in general)

Types of Spinal Cord Injuries

* A neck injury is not lethal unless it is above C2 or 1, possibly C3
* If you don’t regain function in 3 days you aren;t getting it back
* If you herniated a disk into the spinal column you have a problem; most discs herniate outwards
* Subluxation of the vertical column 
* Dislocation - usually breaks the spinal cord 
* Before we hit anyone we are checking the spine - for any disks that move

Manuel in-line stabilization Includes:

* Married to the head
* Not the attending- if you do then you cannot do anything
* Wings
* Now calling all movement

Rigid C-Collar - Laerdal

* Useless 
* WIll not protect the spine of the patient
* The biggest threat to the patients c spine is the patient
* The c collar reminds them not to move their neck 
* Legally - it is a restraint 
* If you move the patient without one you are liable 
* Always leave the collar on!
* If patients are sent home in this no spinal injury - strained a muscle in their neck (nothing serious)

Rigid C-collar - Aspen Collar Includes:

* Come in multiple pieces
* Snap together
* Do not let you move at all
* Each piece is selectively fitted to the patient 
* Patients may be sent home in this

Log Roll to LSB Includes:

* Hands are crossed
* Moving all in one space
* Opened the back for assessment 
* As you go down with the board you are scooping but not flicking 
* Move flat axially back and forth
* LSB - Long Spine Board

Flat Lift to LSb Includes:

* Everyone lifts 2 inches, all 12-15 people will lift up
* No rolling movements
* If someone is slightly higher it will even out 

Securing the Patient includes:

* XIX technique 
* Head LAST
* Cross the chest 
* Belt 
* Cross the thighs
* CMS before and after
* Getting reusable headbands 

Head Blocks Include:

* First the blocks
* Then the straps
* High to under chin to high
* Low to forehead to low
* TAPE!!! - strapping tape as far as we can

What are Fractures?

* Any Break in any bone; no matter how small
* Major types

Traverse Fracture

Directly across perpendicular to the bone

Oblique Fracture

Not Perpendicular

Longitudinally Fracture

Straight down like a hot dog; bone breaks a long way down

Oblique with displacement fracture

Stupid shard, going to bleed into the compartment

Spiral Fracture

Snapping obliquely or in a spiral

Commutated Fracture

Lots of shards

Impacted Fracture

Two bone ends are in communication; usually shattered and all bone ends are force welded together

Avulsion Fracture

Femur or humerus

Segmented Fracture

Broken in 2 or more pieces; not fractured or shattered; two longitudinal fractures

Taurus aka Buckle Fracture

* Structure of the bone itself gives way and bows out. All parts of the bone are still together
* Like pushing two pieces of clay together

Greenstick Fracture

Like when you snap a stick and the inside filps out; mostly in little kids

Displaced Fractrue

Bones are not lined up anymore

Colles Fracture

In the squishy bone and involve the growth plate

A Crush Injury is what?

* Limb or area of the body has been compressed with pressure beyonce blood pressure for more than six mins 
* I.e. motorbike falls on someone - pressure overcomes bp and knocks out circulation 
* Tourniquets have it on for 22 hours 
* Do not even feel that a leg will have to be amputated due to the tourniquet, the tourniquet is only restricting blood flow, not causing any damage

Crush and Compartment Syndrome is what?

* Crush injury and compartment syndrome are two different conditions that produces somewhat similar issues
* Crush injury - where the body or part of it is compressed under a weight that exceeds the blood pressure and structural capacity of the area
* Compartment syndrome - where a part of the body, a compartment, swells to the point that the pressure within the compartment exceeds blood pressure

Rhabdomyolysis includes:

* Dissolution of skeletal muscle 
* Muscle death and muscle inner bits spill into the body, kidneys try to fix it but they can’t (rotting kidney)
* Release of :
* Creatine Kinase (CK)
* CKMB - test for ACL component in the heart (checks for heart attack, if ckmb is elevated)
* Aldolase Lyase
* Lactate (enzyme that’s in the pancreas)
* Electrolytes
* Symptoms:
* Muscle pain in major muscles
* Muscle weakness/chest pain
* Tea colored urine 
* Outcomes:
* Kidney damage - cardiac anomalies 
* Pain, a lot of pain but if its gone a little bit longer (circulated through the body) they will start to alter and have global muscle weakness

Crush Injury - Mechanism Includes:

* Any time the body or a part of it is compressed beyond the structural or psychological limit of the organism 
* Common mechanisms include
* Building collapses
* Auto accidents 
* Weight room incidents 
* Industrial incidents 
* Disasters 

Crush Injury - Patho-physiology Includes:

* The pathology is highly dependent on the weight of the crushing object and the time crushed
* Low weight/long duration is just as damaging as high weight/ short duration injuries
* This results in skeletal muscle destruction and uncontrolled release of the intracellular components in blood circulation 

Crush Injury - Presentation (SM 2 Skill) Includes:

* Crash injury can present the following:


* Hyperkalemia/ hypernatremia 
* Electrolyte imbalance 

Crush Injury - Tx includes what:

* Cardiac monitoring - electrolyte balancing 
* So long as there are no indications of congestive heart failure and infusion rates are high; there is evidence for a non potassium sparing diuretic 
* Mainly LARGE volume fluid resuscitation, be careful of fluid backup into lungs
* So much fluid that the lungs have to be constantly listened to to make sure they are not being filled with fluid 

Crush Injury - Prognosis includes what?

* Prognosis depends on the management of electrolytes, degree of rhabdomyolysis and level of fluid resuscitation 
* So long as the heart is protected and the kidneys stay functioning the patient should systematically recover
* The limb or crushed part may not survive 
* Protect the heart, lungs, and kidneys, systematically the patient should recover ; the limbs may not survive

Fasciotomy / Fasciectomy include:

* Think of snake bite incident, you cut the area with the most pain in order to relieve the pain
* Can cause nerve damage (either before or after)
* Collateral silver mushed into the wound in order to keep it from having bacteria

What is Necrosis?

a bunch of cells that die at once; unprogrammed cell death

Pediatrics generally Include:

* Pediatrics is a completely different game 
* They are not little adults
* Organs, immune systems, endocrine systems, and compensatory mechanisms all operate differently

The Pediatric Assessment Triangle generally consists of what?

* Appearance
* Work of Breathing
* Circulation to skin
* 90% of peads is their appearance
* Are they following the movement?

Retractions and see-saw breathing usually is when…

* Kids do when they can’t breathe
* Use diaphragm and muscles to shift down and create pressure
* Contract all abdominal muscles and force all the air back out again

What is an Affect with kids?

Kids often do not scream and cry when they are seriously hurt

Keys to managing Peds would be what?

* Look them in the eyes
* Get on their level 
* Talk softly 
* The higher pitch the voice is - high pitch language activates a calming reflector in kids which goes around in age 5ish
* Ask to touch 
* Give them autonomy
* The more decision making you give the kid the better
* If you ask if you can help their broken arm and they say no start far away i.e. need to get to right arm, start on left foot’s toe 
* Start far away 
* Use analogs
* Use anything possible; use their bear and get its blood pressure 
* Be honest with them 
* Never tell them it’s not gonna hurt 

Growth Trajectories determined at two times in their life, this means what?

* Before age 5 (how much calories protein calcium, percentage of protein as a diet)
* Height at age 4 5 6 8 you can guess how tall they will be 
* At menarche the projected height is normally as high as they will go (women)
* For men it is usually around 10-11th grade 
* Body mass trajectory is from 3-5 on average 

When does a Pedi stop being a Pedi?

* No hard and fast deadlines
* Some guidelines

(0-30 days- neonate

30 days - 1 year infant

1 yr to 2 yrs toddler

2yrs to 5 yrs preschooler

5yrs - onset of puberty school age

Onset of puberty - about early 20 adolescence Early 20s+ adult

Later in life geriatric

After age 35 the uterus is considered geriatric (women)

\
Geriatric: aged to the point of losing functionality)

What is onset of puberty?

* What is the onset of puberty 
* Men 
* Development of underarm hair 
* Women 
* Breast bud development 
* Menarche (105 lbs/22% body fat)
* Not set in stone, fluid 
* Development can be uneven 
* Use common sense 
* Natalie’s m and m idea 
* You have a bag of m and ms when you are born 
* You cannot eat any of them before you’re \~13 since she says you can’t have sugar 
* When you turn 13 your mom says you can have one 1 m and m a month 
* Eventually you are going to run out of m and ms 

Safety in VANs

* You are __**not**__ counselors
* Be a __**gateway**__ to resources
* Your care/ safety priorities 
* 1st - yourself 
* 2nd -  other sports med 
* 3rd - bystanders
* 4th - players/ staff/ coaches
* 5th - patient
* You, as a peer, might be the __**only one**__ with the interpersonal knowledge to realize something is wrong 
* If you see something, say something, it may save a life 

Reporting Requirements in VANs

* Who are mandatory reporters?
* Counselors 
* Any adult on campus 
* If anything crosses the threshold they have to report it (double edged sword)
* Who are designated / expected reporters?
* People who have a legal responsibility to report but are expected to do so 
* Maintain trust 
* Understand where your lines are
* All about being open
* Situationally dependent 
* What can you live with?
* Reporting hierarchy 
* 1st - Counselors/ Coaches 
* Harris, Womeldorf, & Navarro
* 2nd - Principals/ Vice-Principal(s)
* 3rd - Teachers 
* 4th - Staff 
* 5th - Leadership
* Anyone with bars on
* Threshold for negligence 
* Not a mandated reporter so a level of protection 
* Implied duty based on a reasonably prudent person - would someone in the same shoes as you act in the same way you did 
* __**Always take jokes seriously**__
* Means(everybody has a means); is this an ideation or has this moved onto planning? Never rest on they don’t even have a plan yet

Negligence Review

* The Five Conditions of Negligence 
* Duty to act 
* Breach of duty 
* Cause in fact 
* Proximate cause 
* Monetizable damages 
* Statutory Damages/Compensatory Damages 
* This can be implied by recklessness 
* Would a reasonably prudent person do what you did

Case Study: Jim is a blue shirt trainer assigned to the boys basketball team. Jim's girlfriend Jane and him are very close. You notice that Jim started to wear long sleeve shirts and is keeping to himself a bit more. Before practice you notice there are bruises of various ages on his arms and chest; you ask him about it and he says he got in a fight with Jane but he is okay. “No big worry” you don’t report it to a coach or leadership. Two days later Jim is taken to the hospital after Jane hit him with a cricket wicket, broke a rib, and punctured a lung. 

* Are you negligent? Why? How did you meet the criteria?

* Monetizable damages - Can Jim’s parents make a case 
* Yes - hospital bills 
* Proximate cause/ cause in fact - If jim acted could that have changed the situation 
* Yes 
* Breach in duty - did jim have a direct duty 
* No since he doesn’t specifically tell someone; not a mandatory reporter 
* A Reasonably prudent person would make that report reckless nonfeasance?

Pattern Bruising vs. Pattern Trauma

* Contusions from play are rarely defined 
* Pattern bruising is where you can tell from the bruise what called it 
* Might be part of play/practice, __depends__ 
* Pattern trauma is the same injury over and over again 
* Pattern trauma might be part of normal practice/play __depends__ 
* Think about the age of the bruises 
* Multiple bruises with various ages(colors) is a huge red flag that needs explanation 
* Various ill defined bruises of various ages might be indicative of a C/FC or IC sport however don’t dismiss out of hand 
* Pattern burns 
* Think about a kid being forced into a hot bath, burn line without their bottom since the bottom of the bath is cooler 

Intimate Partner Violence / Intimate Partner Abuse

* Includes: Close Friends, Romantic Partners, Family Members
* Acting in a way that hurts one partner or creates an inequitable power dynamic 
* Types:
* Physical 
* Emotional 
* When the partner knew that his girlfriend was allergic to strawberries so they ordered strawberry desserts knowingly so she couldn’t eat it continually
* Financial / Material 
* Are they paying for everything; i.e. forcing the partner to drive everywhere - wear and tear on vehicle, not paying for gas 
* Psychological
* Gaslighting 
* Exploiting someone’s psychological issue i.e. bpd, adhd, depression and you use those as leverage points 
* Religious 
* Withholding of the ability to worship based on unequal power dynamic 
* Sexual 
* Unequal power dynamic so no consent is given since the person isn't free to say “no” even if the person would’ve said “yes” 
* You are **not** a mandatory reporter however you might be the only one who sees what is going on in time to stop it. **YOU DON’T STOP IT! YOU** __**GET SOMEONE**__ **WHO CAN!**
* Corporal punishment should not leave a pattern bruise - once it does it crosses the line 
* Once there is an unequal power dynamic, consent cannot be given

Remember the Honey Pot!

* Honey pot is a powerful form of HUMINT (human intel, getting someone to tell you everything)
* Can be extremely powerful in digital age 
* Sexting 
* Revenge porn 
* Rumors 
* **Extremely hard to combat / stop once items hit the internet** 

Stages of Predation Include:

1. Conditioning
Equating feelings of intoxication, affirmation, or exhilaration with the predator
Victim never realizes what's happening, usually, some realize it but don’t act on it usually when they have low self-worth
2. Isolation
Removing the support structure for the victim
3. Linking
Financially, Emotionally, Domestically connecting the victim to the predator
Oftentimes a baby happens here, now linked with said person forever
4. Indoctrination
Creating rituals and behaviors that the victim will complete
First stage in complete control
“Then I'll try something else that's bigger”
5. Control
The predator has power over the victim over all aspects
Anytime someone says “if you truly love me you would do this”

Always remember that…

Anyone can fall victim to predation, no matter how smart or informed they are

Neglect Includes:

* The purposeful withholding of companionship, love, and support 
* Three types 
* Self-neglect 
* Not taking care of yourself, not doing the things that you need to do 
* Neglect 
* Ghosting(withholding emotional and physical contact, using the relationship as leverage by removing the relationship)
* Threat of neglect is usually enough (grandma i need money, no, then you won’t see the grandkids for six months, i can give you some money)
* Abandonment 
* Dropping someone off in the middle of nowhere - emotionally or physically
* This can be its own thing or a symptom of IPV/IPA
* This should be different than the waxing and waning of friendships. There is an unequal power dynamic here that goes beyond friends

How do you prevent VANs?

* Student trainers are the __**first & best line of defense**__ for out student community 
* You will see more and be told more than an adult 
* Talk to your friends, be honest about their relationships, amd build a community of trust 
* Students / people with a strong support system are less likely to have long term issues 
* Predators will target individuals who are disconnected and have limited supports 
* If you suspect something, __**tell someone**__!
* Even if you are wrong it is better to tell someone and be wrong than to withhold information and someone becomes a victim 

Poisoning vs. Envenomation, explain

* Poisoning - Did you eat it or absorb it?
* Frogs
* Envenomation - Did it inject it into you?
* Snakes

Spiders?

* Brown recluse 
* Size of a dime up to a nickel
* If light brown also have a violin shaped mark on their back
* Kill the brown spider - “if it’s a little brown spider, smashy smash”
* When they bite you the inject a necrotite injecting venom which digests your tissues; looks like a bullseye at first 
* The only way to stp it is to cut the lesion out if it starts to necrotize 
* If gets to the fascia it just travels around it and sloughs off everything around it 
* They are recluses and will hide somewhere
* Black widow
* Common
* Not going to kill you
* If you are above 85-90 lbs just a headache and stomach ache (muscle contractions and cramping all throughout your body) with diarrhea 
* Little people are going to have a neuro problem and the diaphragm will have cramping
* Nectorize tissue since the body doesn’t have enough mass to dilute it through the bloodstream
* Relatively harmless as long as you don’t make them mad

Snakes?

* Black Diamond Rattler
* Pit vipers
* Sense thermal; see infrared through pits 
* More active hunting at night, better temperature differential
* Coral Snake
* Red to yellow kills a fellow; red to black you’re coming back
* Western Diamondback
* If the snake looks like that you’re screwed
* It doesn’t want to strike you but it will if you don’t slowly back up
* Enough to venomate an adult three times
* Prairie Rattler
* San Joaquin valley; invasive species 
* When you cut the head of a snake off its envenomation glands auto ejects, bury it unless you have a dog
* Adult rattlesnakes will change the dose of the venom depending on your size, baby rattle snakes will inject it all as they cannot change the dose
* Rattlesnake injuries will have swelling - cut off everything; necklaces, wedding rings, shirts
* We do have antivenom but 1 out of 2 people are allergic to it so you get epi at the same time

What about Poison Oak

* Leaves in bundles of three
* Oil on the surface of the leaves and sap
* Transdermal; will go through the skin so it can can be transmitted to other surfaces and people
* “Leaves in Threes”
* Neutralize it in vinegar and spray it all over the plant
* Weeping effect of the oil out of the skin
* 1 out of 5 people will be immune to Poison Oak
* Vinegar won’t necessarily work on humans - need soap to cut through the oil and wash it away and quickly do the oil doesn’t weep down the leg

High Altitude Emergencies: Acute Mountain Sickness (AMS)

* Anorexia 
* Nausea
* Vomiting
* Insomnia
* DIzziness
* Lassitude
* Fatigue
* Lightheaded
* Cannot do anything to fix it except go in a lower altitude or less oxygen)
* Cannot sleep since heart is racing
* Takes minutes to hours

High Altitude Emergencies: High Altitude Cerebral Edema (HACE) (Not in CA; not high enough altitude)

* Headache
* Disorientation
* Loss of coordination
* Memory loss
* Psychotic behavior
* Coma
* Same as HAPE but also with the brain

High Altitude Emergencies: High Altitude Pulmonary Edema (HAPE) (more common than HACE)

* Chest tightness
* Persistent cough
* Frothy sputum
* Feeling of impending suffocation during sleep
* Not enough pressure in the lungs to force the fluid out of the lungs
* Solve through CPAP by increasing pressure of the lungs 

High Altitude Emergencies: HAFE high altitude flatulence expulsion

* Altitude inside is still at high pressure while the outside isn’t
* The pressure needs to go somewhere
* Problem for infants 
* Anything over 18,000 feet is going to be lethal quickly 

H&H (Hemoglobin and Hematocrit), explain

* Hematocrit - percentage(%) of blood that is RBC (red blood cells)
* Usually biosex males \~40-45%
* Usually biosex females \~32-38% 
* Amount of hemoglobin that carries oxygen is ⅓ of that
* BF \~11-13 per deciliter
* BM \~18-19 per deciliter
* When you come down to a lower elevation you can play at a better level
* Erythropoietin - hormone your kidneys use to tell your bone marrow to make more red blood cells
* If you’re not controlling it right you can easily turn your blood so thick that you stroke out
* Which is why athletes give blood every two weeks - to make sure their blood doesn’t get too thick

Altitude Impact Report (AIR)

* Complete before traveling through or to an event over 250m in altitude. 
* Should Include
* Altitude at event 
* O2 at event
* Potential Impacts to Athletes
* Risk of AMS, HAPE, HACE
* Given to coach
* Along with the Flag at the location.
* How to respond will be at coach’s \n discretion. 

What is Escar

Burned leathery tissue

* Form after 3rd and 4th degree burns 
* Dead tissue on the surface of the skin 
* Can act as protection 
* The area on the top has all the water taken out of it and turns into charcoal 
* May need to be scraped off or infected since no white blood cells there 
* If beings to constrict may need escharotomy 
* Eschar will constrict as it dries and can cut off blood flow like a tourniquet (similar to leather)