Basic Wilderness Life Support

Bybenmunoz

This was from a wilderness medicine course I took at BCM.

The Big Idea: boil all water, clean wounds with soap and water, wash off poison ivy within 1-4 hours, do not suck out snake venom, splint possible fractures, seek medical attention 

Essentials for Wilderness Travel

  • map, compass, knife, matches, flashlight, first aid kit, sunglasses/sunscreen, extra food, extra clothes, water
  • first aid kit/prevention: blister prevention, insect repellant, gloves
  • first aid kit/procedures: splint, scissors, duct tape, zip lock bags, safety pins, tweezers, syringe
  • first aid kit/medication: topical antibiotics/antiseptics, tylenol, imodium, benadryl, hydrocortisone cream, aloe, antifungal, epipen
  • first aid kit/wound: gloves, bandaids, irrigation, wound closure strips, moleskin, povidone-iodine, benzoin, dressings, antiseptic towelletes, alcohol swabs, gauze, antibiotic ointment, Ace bandage, Q-tip, triangular bandage
  • vehicle first aid kit: large burn dressings, rope, splints, blankets, radio, shovel, chains, food, water, fire extinguisher, candle, saw, flares

Water

  • use screen (bandana) to remove debris
  • let water stand for debris to settle, then decant from the top
  • boil to kill hep A, bacteria, enteric viruses, crypto, giardia
  • if you can’t boil, filtration works for all except viruses
  • if you can’t boil, chemical disinfection (iodine/chlorine) works for all except helminths and protozoa
  • chlorine dioxide is highly effective against all

Assessment

  • ABCDE: airway, breathing, circulation, disability, environment
  • if not breathing, CPR: 30 chest compressions, 2 rescue breaths
  • never move a victim with possible spinal injuries, unless you have to

Wounds

  • abrasions: minimal blood loss, painful, foreign objects
  • lacerations: high risk of infection, foreign objects, animal bites
  • first degree burn: red, treat with aloe, damp cloth
  • second degree burn: blistered, treat with cool water, antibacterial ointment, dressing, possible evac
  • third degree burn, victims of fires: all layers burned, nerve damage, possible reduced pain, evac
  • 1st treatment for bleeding: direct pressure for several minutes, longer for scalp wounds
  • 2nd treatment for bleeding: after direct pressure, pressure points (axillary artery, femoral artery) and elevation
  • tourniquet: last resort for bleeding, may result in amputation, tie a cloth around limb and tighten by turning a stick through the knot
  • irrigate wound with lots of clean water to help prevent infection
  • remove foreign matter from wound if possible
  • don’t worry about closing a wound, worry more about irrigating and dressing it well
  • use tape to close a cleaned and irrigated wound
  • dressing: antibiotic/antiseptic ointment, dressing, gauze, tape
  • check dressings 1-2x daily for infections
  • alternative topical antimicrobial: unprocessed honey
  • scrub abrasions well, even if painful
  • keep thumbs and fingers for possible re-implantations, keep cold but do not ice directly
  • lacerations to eyelids, ears should evac
  • deep lacerations to limbs: test strength, full range of motion, sensation, for possible tendon and nerve damage
  • puncture wounds: don’t forcefully irrigate or might push in debris, scrub and dress, do not close, evaluate frequently for infections
  • bites: clean very well, look for debris, evaluate frequently for infections
  • blister: okay to puncture large blisters

Sprains, Dislocations, and Fractures

  • sprain: stretching or tearing of ligaments, knee/ankle, similar symptoms to fracture
  • dislocation: bone pulled out of its socket, shoulder, elbow, finger, kneecap, compare joint to the uninjured side
  • fracture: closed vs open, difficult to diagnose without X-rays
  • sprain/fracture: assume it’s fractured, splint, evac
  • neck/back, pelvic, femur fractures: very serious, helicopter evac
  • splinting: remove jewelry before swelling, recheck circulation and sensation after splinting
  • sprain: RICES for 72 hours (rest, ice, compression, elevation, stabilization)
  • dislocations: reduce if you know how, otherwise evac

Drowning

  • drowning: body involuntary breathes, water enters lung, lung injury, decreased oxygen to brain, death if not rescued
  • pass out after 3 minutes, brain damage after 5 minutes
  • CPR if victim not breathing: 2 rescue breaths, 30 chest compressions
  • no special drainage procedures to empty water out of the lungs or stomach
  • if no symptoms, observe victims for 6 hours

Medical Problems

  • chest pain: rest and take a history (OLDCARTS), if in doubt chew aspirin and evac
  • shortness of breath: rest and take a history (OLDCARTS), if no resolution evac
  • seizures: let it run its course, after it stops roll patient on side, first time seizures (low blood sugar, head injury, CNS infection, toxicity, stroke) require rapid evac
  • stroke: lack of blood flow to the brain, helicopter evac
  • diabetes/low blood sugar: clammy skin, weakness, confusion, give sugar and evac
  • Read up from a reliable resource about CPR, and about heart attack prevention
  • diabetes/high blood sugar: confusion, blurry vision, nausea, fruity smelling breath, give lots of fluids with electrolytes, evac
  • local allergic reaction: cold packs, hydrocortisone cream, benadryl
  • generalized allergic reaction: epipen+benadryl
  • abdominal pain: too many possible causes so just evac

Bites and Stings

  • get your tetanus vaccination
  • all wounds: irrigate with water, clean with soap and water, dress with clean cloth
  • dog/cat bites: consider oral antibiotics
  • wild animal attacks in the US are rare
  • rabies: skunks, raccoons, foxes, bats
  • black bear: try to scare away, if attacked get into fetal position
  • brown bear: stand quietly, do not run, if attacked get into fetal position
  • cougar: do not run away, try to scare off, pick up children
  • snakes (pit viper): mostly hemotoxic, support airway/breathing/circulation, evac, bite kits ineffective, do not tourniquet, do not use alcohol, do not use aspirin, do not ice
  • snakes (coral): red on black venom lack — red on yellow kill a fellow, wrap limb tightly in elastic bandage
  • mosquitos: most active at dusk, use DEET, put campsite should be high and away from standing water
  • spiders (black widow): catch the spider, clean the bite with soap and water, evac
  • spiders (brown recluse): painless bite, swollen after 2-8 hours, catch the spider, clean the bite, look for white core with white/blue border, elevate limb, systemic signs means get to hospital
  • spider (hobo): brown spider with yellow green dorsal abdomen, no need to evac unless systemic symptoms
  • ticks: remove ticks within 48 hours to prevent Lyme, use twizzers only
  • ants/bees/wasps: treat generalized allergic reactions with epipen
  • scorpions: only bark scorpion is dangerous, clean sting, apply ice and oral pain meds, rapid evac if bark scorpion
  • jellyfish/man-o-war: rinse with seawater/vinegar (except man-o-war)/alcohol, do not use freshwater/rub/warm water
  • sea snake: begins painless, then aches and fatigue within 2-3 hours, immobilize limb, no ice, no suction, no incision, rapid evac
  • poison ivy/oak/sumac: poison ivy = leaves of three let it be, never burn the leaves, watch with soap and water within 1-4 hours, hydrocortisone cream asap (except face/genitals), benadryl/calamine for relief

Lightning

  • most common cause of death in a lightning victim is cardiopulmonary arrest
  • continue to give rescue breathing once a victim recovers a pulse because drive to breathe is often delayed
  • treat unconscious/no-pulse/no-breathing victims first (reverse triage)
  • no need to worry about touching a lightning strike victim
  • avoid being the tallest object in an open field
  • avoid being next to the tallest object in an open field
  • seek shelter in a low area under small trees
  • avoid open doors and windows, metal objects

Heat Injuries

  • heat cramps: oral salt replacement and hydration
  • heat fainting: lie the victim flat so blood can flow back from legs to brain
  • heat exhaustion: cool victim and rehydrate
  • heat stroke: emergency, lack of active sweating, CNS disturbance, ice packs, evaporate cooling, rapid evac

Cold Injuries

  • hypothermia: rewarm the patient
  • cold rescue: no one is dead until they are warm and dead
  • frostbite: elevate the extremity, thawing and rewarming should be done by a doctor, doctor will rapid rewarm with warm water not fire
  • trenchfoot: rewarm foot, resolves spontaneously

Altitude Sickness

  • acute mountain sickness: rest, tylenol
  • high altitude cerebral edema: unsteady gait, fatigue, immediate descent and evac, full recovery can take weeks
  • high altitude pulmonary edema: shortness of breath at rest, immediate descent and evac