Wilderness Medicine Training Center (WMTC) General Info & Basic Life Support

The field of wilderness medicine…

is NOT nationally regulated.

SOP

Scope of Practice

Duty to Act

p is under your care, Good Samaritan Act

No Duty to Act

no prior relationship with p, Good Samaritan Act

Good SAM

unscheduled, provided at the scene, without compensation, must have consent, must continue until danger subsides, must not abandon

MOI

Mechanism of Injury or Illness

The 3 MOI

traumatic, environmental, medical

signs and symptoms

S/Sx

based on their clinical patterns

Problems are diagnosed and treated…

Compensatory Mechanism act to…

correct the problem and maintain homeostasis

The 3 Critical Systems

respiratory, circulatory, nervous

If one critical system crashes…

the others soon follow

Locations of the 3 Critical Systems

cranial, chest, abdominal

AVPU Scale

Awake & Alert, Voice responsive, Pain responsive, Unresponsive

Various Levels AVPU

Awake & alert, Awake & confused, High voice responsive (V+), Voice responsive (V), Low voice responsive (V-), Pain responsive (P), Unresponsive (U)

Awake & Alert

answer questions, speak coherently, initiate conversation

Awake & Confused

awake however confused about the situation and where they are

High Voice Responsive (V+)

doesn’t initiate conversation, speak in words, appear to go “in and out” of consciousness

Voice Responsive (V)

responds with groans, can hear but can’t be understood

Low Voice Responsive (V-)

can’t respond with voice but can respond to simple motor commands

Pain Responsive (P)

can’t speak or move but respond vocally or physically to pain

Unresponsive (U)

p is unconscious

Level 1 Urgent Evacuation

p’s MOI is immediately life threatening, p may die without hospitalization, all VPU p

Level 2 Urgent Evacuation

p’s MOI is potentially life threatening and/or will result in permanent disability

Level 3 Non-urgent Evacuation

MOI can be treated on the field however p can’t resume normal activity within reasonable time and/or requires advanced assessment

Level 4 No Evacuation

p is able to resume activity within normal time with no threats to long term quality of life

inflammation, phagocytes, natural killer cells, complement, interferon, fever

6 Cellular Defenses

Inflammation

chemicals released by inflammatory cells cause vasodilation and increased permeability

Phagocytosis

attack and eat invading microorganisms

24 hours of initial tissue damage

Inflammation and swelling generally reaches peak within…

Antibodies

neutralize invaders outside cells

Killer T-Cells

attack invaders inside cells, chemically destroy the cell

immunodeficiences, autoimmune diseases, allergies, anaphylaxis

Problems with Immune System

more than one response

ALL drugs elicit…

Side effects

an undesirable response to a drug

Pharmacology

the study of drugs

Drugs

chemical substances that have an effect on living organisms

Medicine

drugs used to prevent or treat disease

oral, topical, inhalation, subcutaneous & intermuscular injections, infusions

Administration Routes

patient, drug, administration route, dose, time

Prior to administration, check that you have the right…

parasympathetic, sympathetic

Two types of Automatic Stress Response (ASR)

actions under our control

Somatic division of nervous system

Autonomic division of nervous system

basic life support functions not under our control, breaks down into ASR

Sympathetic system

fight or flight, fear, p cannot give accurate information about injuries

nausea, dizziness, faintness, may mimic signs and symptoms of concussion

damage to Parasympathetic system

Scene survey, Primary survey, Secondary survey

Managing ASR with Patient Assessment System

Breathing Check

feel for warm air with cheek or hand, watch for chest to rise and fall

Rescue Breathes

breathe until p’s chest rises, stop, breathe again after p’s chest falls

foreign object, kink, swelling, fluid

Airways can be obstructed via…

30:2, 15:2

Ratio of compressions to breathes in CPR (adult, child)

flatline, no pulse no electrical activity

Asystole

Ventricular Fibrillation (VF)

uncoordinated electrical activity, heart quivers but doesn’t contract, no pulse

pulseless Ventricular Tachycardia (VT)

coordinated electrical activity, contractions are ineffective, no pulse

coordinated electrical activity, heart muscle unresponsive, no pulse

Pulseless Electrical Activity (PEA)

Defibrillator

machine that sends electrical pulse to p’s heart

VF, VT

You can use a defibrillator for

asystole, PEA

You can’t use a defibrillator for

CPR

combination of chest compressions and rescue breathing

CCR

chest compressions only

Primary tools for blood loss

direct pressure, pressure bandages, commercial tourniquets, hemostatic agents

Torniquets

straps used to cut off blood supply to wound

thoracic or abdominal cavities

Do not pack wounds that extend into…

Tx

treatment