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