|
You are on a three-week canoe expedition in the boundary waters. One of your students, Ximena, approaches you before breakfast complaining of pain and swelling in her ankles; she thinks it's a reaction to the black fly bites she received a couple of days ago when she forgot to reapply DEET after swimming. Yesterday the bite sites were slightly red and itchy. This morning, upon awakening, both her ankles are swollen with red streaks moving up her lower legs. She is tired and feels sick. Her core temperature is 101º F (38.3º C). It's day 14. What is wrong with Ximena and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
0 Comments
You are a Forest Service wildland firefighter supervisor and trainer. You have a strenuous field exercise planned for tomorrow for a new cadre. Unfortunately, an unseasonable heat wave is in place and the high temperature predicted for the day is in excess of 110 degrees F. What are your concerns and how should you address them? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You and your partner are planning a two or three day backpacking trip near your home in Boone, NC with your seven year-old daughter and six year-old son. They have been car camping with you for the past three years, taken short day hikes, and enjoyed both. Your daughter is severely allergic to wasps and poison oak; she was hospitalized at four after being stung by a yellow jacket in your backyard. How should you plan your trip? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are part of a hotshot crew responding to a wildfire in northern California. Temperatures are well into the triple digits close to the handline they were tasked with holding. James, one of the crew members, is complaining of the heat and it's difficult to keep him cool. During your patient assessment, you find that he has recently started taking Benadryl® for a newly developed allergy to juniper pollen. What do your think is wrong with James and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are paddling with two friends on the Farmlands section (Class VI-V) of the White Salmon River in Washington state. The day is sunny and 65 degrees F but the water temperature is quite cold at 45 degrees. Most of the river is behind you when one of your friends Jessie, gets offline and runs the slot. Her kayak completely disappears for a few seconds before popping up downstream upside down. There is no sign of Jessie. Chasing her, you see her get scraped out of her boat as it drags over a submerged rock. It takes another 3-5 minutes (?) to rescue her. Once on shore, she is unresponsive, not breathing, and does not have a pulse. You pull her onto a flattish rock and begin CPR. During the second round of chest compressions, a small amount of foam issues from her mouth and nose. You breathe through it. Roughly three minutes later she spontaneously begins breathing. Ten minutes later she is awake and confused with no memory of the event. Her helmet is cracked and her physical exam is unremarkable. She is shivering even though the rock she is on is in the sun; she is wearing a drysuit. Her pulse rate is 52 and regular; her respiratory rate is 16 and easy; her lungs appear dry with no rales, gurgling, or coughing. The Green Truss bridge take out is just downstream and requires ropes to haul your kayaks to the rim. Once at the rim, a clinic is about an hour away and a small hospital an hour further. Jessie wants to get off the water and go home. You have cell coverage. What is wrong with Jessie and what should you do? Click here to find out. Click here to read a blog article on drowning. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are leading a father/son day hike for a local camp. The father's ages range between 35 and 54 with various levels of fitness; their sons are 11 or 12 years old. The hike is a point-to-point hike covering a total of five miles. You are currently a hiking up a rather steep grade to a prominent overlook; there is only a few hundred feet to the top and just over a mile remaining to your pick-up spot. The day is sunny and hot with an ambient temperature of 88º F. One father, Bill, an overweight man in his early 50s, repeatedly stops to catch his breath on the hill. After his second rest stop you move him to the front of the group in an effort to keep the group together and slow the pace. Upon reaching the top at 3 PM he is clearly exhausted, slightly pale, sweating heavily, and complaining of the heat; the slight breeze at the overlook is clearly welcome. While resting, he admits he "is more out of shape than he thought" and relates that he is otherwise healthy with no personal or family history of heart disease; although, his physician has been trying to get him to start statins to lower his cholesterol. He can't remember the last time he urinated or the color of his urine at the time; he thinks it was when he woke up this morning. He reports drinking about a quart of water on the hike thus far but not snacking; he is very thirsty now. His color returns and after 10 minutes, his pulse is 86 and regular, his respirations are 20 and easy, and his oral temperature is 102º F.
What do you think is wrong and what can you do about it? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are leading an interpretive day hike down the Bright Angel Trail of Grand Canyon National Park for a local concessionaire. People sign up for the hike online or at the concessionaire's Flagstaff office; they do not complete a medical form. It is a 9-mile out-and-back hike; water, shade and bathrooms are available at Indian Garden, which is the turn-around point. There is also water and a resthouse at 1.5 and 3 miles. It's mid-August and the temperature is expected to reach triple digits by early afternoon; the hike is scheduled to leave the Backcountry Information Center at 7 am. Participants are asked to arrive at 6:30 am with a day pack that includes snacks, lunch, water (at least two liters, one bottle should be frozen), and sunscreen. They are also instructed to wear light-colored clothing, a wide-brimmed hat, and sun glasses. During your pre-hike safety talk, no one responds when you ask if anyone has any medical conditions you should be aware of. The day heats up quickly and it's close to 90º F by 10 am and travel has been slower than expected. You are close—a quarter mile—from Indian Garden when one client, a 62-year-old man, begins to complain of the heat. You stop, cool him off using a combination of mist from your spray bottle and fanning. Once he is cool, you continue to Indian Garden, where once again, he complains about the heat. You break out the spray bottle as he sits in the shade. Once he is cool, you take out a SOAP note and do a full patient assessment. During your SAMPLE history you discover that he was hospitalized four years ago for a heart attack and currently taking a beta blocker and a diuretic to help prevent a second heart attack. The client, Tyrone, reports that he has been athletic with no health issues for the past two years. What do you think is wrong with Tyrone and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You and your climbing partner are six pitches up on Goat Wall in Mazama, WA when a sudden lightning storm moves in with heavy rain and lightning. Abandoning the climb you begin to simultaneously rappell off (an advanced—and somewhat risky—climbing technique where two climbers rappel at the same time on the same rope counterbalancing one another). On the last rappell, you neglected to tie a knot on your side of the rope and misjudged the distance to the ground, and rappelled of the end of the rope a few feet above the ground. Unfortunately, your climbing partner, Jessie was roughly 20 feet above you when you fell. With the loss of your counterbalanced weight, the rope pulled through the anchor and Jessie fell to the ground landing on her right side and head in the talus. When you reach her, Jessie is unresponsive and bleeding from her nose and ears; some of the fluid appears to be a light yellow and her helmet is cracked. A quick physical exam reveals a soft spot on her skull behind her right ear and crepitus in multiple ribs on her right side. Her pulse rate is 168 and regular; her respiratory rate is 26 and slightly irregular; her skin is pale. What is wrong with Jessie and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You and a few friends just returned from a hot, weekend backpacking trip in the Superstition Mountains outside Phoenix, AZ. It was the first trip for one of his friends, Alan, who is slightly overweight and unfit, had a difficult time with the heat, distance, and elevation changes. Monday morning, the day after the trip, Alan called you complaining of very sore leg and back muscles; he said he could hardly get out of bed and taking 600 mg of ibuprofen didn't help. What do you think might be wrong with Alan, how do you find out, and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.  Mnemonics in CPR and First Aid: A brief history & discussion A mnemonic is a learning technique that enhances information retention or retrieval by associating a concept or action with letters, words, or images. CPR and first aid commonly use letter mnemonics to describe the treatment order during your initial patient assessment; WMTC uses an image or visual mnemonic and builds it into a larger graphic that illustrates our complete patient assessment system. In 1957, Peter Safar, MD, a pioneer in resuscitation techniques, wrote the book ABC of Resuscitation. The ABC mnemonic—airway, breathing, circulation—and its associated techniques were described in a 1962 film, "The Pulse of Life," to promote and bring CPR training to the lay public. The film won six major awards, and the following year, in 1963, the American Heart Association [AHA] officially endorsed CPR; the ABC mnemonic became a standard part of their CPR training program in 1973. The mnemonic was later adopted by the first aid community and used during the initial assessment of an unconscious patient. Because the ABC mnemonic was easy to remember and reflected the order of action as determined by research at the time, it was widely adopted. As interest in outdoor recreational activities—rock climbing, mountaineering, backcountry skiing, white kayaking and rafting, canyoneering, hiking, etc.—grew, enthusiasts and guides alike found that urban first aid courses did not address the needs of remote travelers. With the emergence of wilderness medicine protocols and courses, other letters began to appear in the ABC mnemonic after the C: D for "disability" [referring to the cervical spine], E for "exposure" [to environmental insults], F for "fluids" [blood, cerebrospinal fluid, vomitus, etc.], and even G for "go" [evacuate]. The additional letters had three things in common:
Then, the research data changed the order of the letters in the ABC mnemonic. The AHA found (1) it was slightly more effective — on average roughly 20 seconds faster — to start chest compressions once a rescuer determined a patient was in cardiac arrest than to begin with rescue breathing, especially if a barrier device was used. They found that a person in cardiac arrest from a heart attack had enough residual oxygen in their lungs to oxygenate their brain for 4-6 minutes without rescue breaths if a bystander started pushing on the patient's chest. In 2010, the AHA changed the ABC mnemonic to CAB to reflect the change in treatment and the importance of initiating chest compressions before beginning rescue breathing during CPR when the arrest was due to a heart attack. Note that the ABC mnemonic accurately reflects the treatment order if the cardiac arrest was the result of a primary respiratory problem like drowning, snow burial, lightning, and overdoses where a lack of oxygen caused the arrest. In these cases, it is essential to begin rescue breathing ASAP. During the Middle Eastern wars, the US military found that the rapid application of extremity tourniquets saved lives; in fact, a lot of them. They also discovered that, in some cases, it was possible to apply a tourniquet and later remove it after packing the wound with hemostatic gauze and applying a pressure bandage; this practice saved limbs. Over time, EMS adopted a similar protocol, and instead of tourniquets being used as a last resort to stop severe bleeding, they became the first. To reflect the treatment change, the US military replaced ABC with X-ABC [eXsanguinate, Airway Breathing Circulation] or MARCH [massive hemorrhage, airway, respiration, circulation, head injury/hypothermia]; both of the new mnemonics supported the immediate application of tourniquets to address severe arterial bleeding, rather than the application of direct pressure followed by a pressure bandage with a tourniquet as a last resort. Fortunately, the new data and treatment protocols easily transfer to civilian applications; the mnemonics, however, not so much. Some mnemonics work better than others, depending on the individual, how their mind works, what mnemonic they were taught first, and the situation. Adding additional letters to a classic alphabet mnemonic is pretty easy to do; however, confusion and frustration can set in when a widely accepted alphabet mnemonic changes its letter order under certain situations — like when the AHA changed from ABC to CAB for heart attack patients in cardiac arrest and left ABC in place for arrests due to a primary respiratory problem forcing students to reorient their thinking choose the correct treatment order [and mnemonic].
So, is one mnemonic better than another? As usual, the answer is: It depends. The ABC alphabet mnemonic has been in use since 1957, and almost everyone is familiar with it. With two notable exceptions—cardiac arrest secondary to a heart attack and severe bleeding—it accurately reflects the order of treatment. If you can remember the exceptions, it works. The same is true for the extended alphabet mnemonics. The order of treatment expressed by X-ABC and MARCH works well for tactical situations and is easy for soldiers to remember, but it shares the same exceptions as the ABC alphabet mnemonics. Is WMTC's 3-triangle image mnemonic better? We think so because its ordered but non-linear structure encourages critical thinking and adapts to real-life scenarios and new research better than an entirely linear system. Will it work better for you? Take a course from us, and you decide! Ultimately, the best mnemonic is the one you can remember and use. 1 (2010). 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation, 122(18).
|
