Wilderness First Aid Reference Cards

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					                                                 Pulse/Pressure Points
  Wilderness First Aid
   Reference Cards


               Prepared by:
         Andrea Andraschko, W-EMT                                     Radial
               October 2006



     Abdominal Quadrants                                 Airway Anatomy
        (Looking at Patient)

 ANTERIOR:                ANTERIOR:
  LIVER                    SPLEEN

 POSTERIOR:               POSTERIOR:
  R. KIDNEY                PANCREAS
                           L. KIDNEY



Tenderness in a quadrant suggests potential
injury to the organ indicated in the chart.
                       Patient Assessment System                                             SOAP Note Information (Focused Exam)
Scene Size-up                         BLS                                     Pt. Information                 Physical (head to toe) exam: DCAP-BTLS,
MOI                                   Respiratory                             MOI                             OPQRST
 • Major trauma                        • Air in and out                       Environmental conditions
 • Environmental                       • Adequate                             Position pt. found              Normal Vitals
 • Medical                            Nervous                                 Initial Px: ABCs, AVPU          Pulse: 60-90
Safety/Danger                          • AVPU                                 Initial Tx                      Respiration: 12-20, easy
                                                                                                              Skin: Pink, warm, dry
 • Move/rescue patient                 • Protect spine/C-collar
                                                                              SAMPLE                          LOC: alert and oriented
 • Body substance isolation           Circulatory
 • Remove from heat/cold exposure      • Pulse                                                                Possible Px: Trauma, Environmental, Medical
 • Consider safety of rescuers         • Check for and Stop Severe Bleeding                                   Current Px
Resources                                                                                                     Anticipated Px
                                       STOP → THINK:                          Past/pertinent Hx
 • # Patients                                                                                                 Field Tx
                                       A – Continue with detailed exam        Last oral intake
 • # Trained rescuers                                                                                         S/Sx to monitor
                                       VPU – EVAC NOW                         Event leading to incident       Evac level
 • Available equipment (incl. Pt’s)

                Patient Level of Consciousness (LOC)                                                      Shock Assessment
Reliable Pt:                          AVPU                                    Hypovolemic – Low fluid (Tank)
Calm                                  A+ Awake and Cooperative                Cardiogenic – heart problem (Pump)      Comment:
Cooperative                           A- Awake and lethargic or combative     Vascular – vessel problem (Hose)        If a pulse drops but does not return
Sober                                 V+ Responds with sound to verbal                                                to ‘normal’ (60-90 bpm) within 5-25
Alert                                     stimuli                             Volume Shock (VS) early/compensated     minutes, an elevated pulse is likely
                                      V- Obeys simple commands with verbal                                            caused by VS and not ASR.
                                                                               • ↑pulse
Causes of Abnormal Consciousness:         stimuli                              • Pale skin
Sugar                                 P+ Pulls away from source of pain                                              Tx: Stop visable bleeding, elevate legs,
                                                                               • ↑respiration rate                   keep warm, manage psychological
Temperature                           P- Moves toward source of pain
                                                                               • Normal AVPU                         factors, ventilate if respirations are
Oxygen                                U Totally unresponsive
                                                                              Volume Shock late/decompensated        inadequate, give O2 and IV fluids if
Pressure                                                                       • ↑↑↑pulse                            available and appropriately trained.
Electricity                                                                    • Pale skin
Altitude                                                                       • ↑↑↑respiration rate
Toxins                                                                         • ↓AVPU
                             Acute Stress Reaction                                                                     Head Injuries
 Sympathetic (fight or flight)              Parasympathetic (rest and digest)        Concussion:                                   ↑ICP:
  • ↑pulse                                   • ↓pulse                                Patient must be awake, cooperative,           S/Sx – early
  • Pale skin                                • Pale skin                             improving, and have amnesia.                   • Patient is A- or lower
  • ↑respiration rate                        • ↓respiration rate                                                                    • C/O headache
  • Normal AVPU                              • May feel light headed, dizzy,                                                        • Persistent vomiting
                                               nauseous, faint, anxious               • Patient is awake now
  • Pain masking                                                                                                                    • Ataxia
                                            (neumonic = PASR = passout)               • Amnesia                                    S/Sx – late
  • Looks like early VS
 (neumonic = SASR = Spin up)                                                          • Can’t have S/Sx of ↑ICP                     • Patient is VPU
                                                                                      • Nausea/vomiting (once) 2° to                • Vomiting persists
Tx: For either condition, calm patient and remove stressors as much as possible         P-ASR
                                                                                                                                    • Seizure
                                                                                      • Headache
                                                                                                                                    • Coma
                                                                                      • Tired
                                                                                                                                    • Cardiac and respiratory arrest

                Spine Ruling Out Process (WFR or WEMT)                                                                 Wound Cleaning
 Patient must:                              Motor Exam: Compare strength in both     Partial thickness:                             Full thickness, high risk:
  • Be reliable                             hands and feet. Have pt. resist:         • Soap and water wash                          Clean as previous, PLUS:
                                             • finger squeeze; pushing down on       • Scrub to remove particles                    • Remove dead skin and tissue
  • Report no pain when focused on
    spine                                      hand                                  • 10% P.I.                                     • Remove foreign material
                                             • push ‘gas pedal’; pull up on foot     • Keep moist                                   • Finish flushing process with 1% P.I.
  • Report no tenderness when spine
                                                                                     • Dress lightly                                   solution (strong tea or amber beer)
                                            Sensory Exam: compare pt’s ability to                                                   • Do not close in field
  • Have normal motor exam
                                            distinguish between pin prick and soft   Full thickness, low to moderate risk:          • Pack with thin layers of gauze
  • Have normal sensory exam
                                            touch on back of hand and shin           • Clean w/in 2 hours of bleeding end              soaked in 1% P.I. Remove and
  • Report no shooting, tingling or                                                                                                    repack bid
                                             • Use pin to prick                      • Clean around area with 10% P.I.
    electric “pain” radiating from                                                                                                  • Dress with several layers of gauze.
                                             • Use cloth for soft touch              • Pressure flush with drinkable water in
    extremities                                                                                                                        May place 10% P.I. between layers,
                                                                                       short bursts along axis
In cases where the spine can’t be ruled out but the injury can be localized to the   • Bring edges toward(not touching) each           but not directly on wound
lumbar area, consult medical direction regarding need to continue c-spine              other and hold in place with an occlusive    • Consider splinting if wound is over a
stabilization.                                                                         dressing and/or steri-strips etc.               joint.
                    Common Causes of Pulse Changes                                                                Focused Survey Acronyms
Strong, Slow:                               Strong, fast:                                From Patient:                               Observed by Rescuer:
    • Normal sleep                              • Early heat stroke
    • Simple fainting                           • Fever                                  SAMPLE = Signs/Symptoms,                    CMS = Circulation, Motion,
    • Early ↑ICP                                • Hyperthyroid                            Allergies, Medications,                     Sensation
    • Well-conditioned athlete                  • Early shock                             Previous Injury, Last Meal/Drink,
                                                                                                                                     OPQRST = Onset, Provocation,
    • Hypothyroid                               • ASR                                     Events
                                                                                                                                      Quality (dull, sharp), Radiation,
                                                • Strenuous physical activity                                                         Severity (1-10), Time
Weak, slow:                                                                                   Pt = Patient
   • Hypothermia                            Weak, fast:                                       Hx = History                           DCAP-BTLS = Deformities,
   • Late ↑ICP                                 • Overwhelming infection                       Px = Problem                            Contusions, Abrasions,
                                               • Late heat stroke                             S/Sx = Signs/Symptoms                   Punctures/Penetrations,
                                               • Late shock                                   Tx = Treatment                          Burns/Bleeding, Tenderness,
     • Sinus arrhythmia                                                                                                               Lacerations, Swelling
                                               • Diabetic coma
     • Heart disease
                                               • Some types of heart disease

                                      Hypothermia                                                                   Heat Related Symptoms
98.6° to 90°:                               <90°:                                        If heat is identified as a potential MOI    Heat exhaustion:
Pt will be A to A-, shivering, have         Pt will be V, P or U; shivering will stop;   and patient exhibits irrational behavior:   A-(irritable), temp. 99°-104°, pale
↑urine output, ↓coordination and            HR and respirations will decrease; Pt
dexterity                                   may appear dead                              1) ALWAYS COOL PATIENT FIRST                Heat stroke (early):
                                                                                         2) Assess hydration status                  A- (irritable, combative), temp. >105°,
Tx:                                         Tx:                                            • If dehydration is established,          pale if dehydrated, flushed if hydrated
Active rewarming – give food (carbs         Passive rewarming – add insulating               hydrate with electrolyte solution
first), liquids, remove from elements,      layers (hypowrap), handle with care,           • If hx includes copious H2O, give        Heat stroke (late):
exercise, shelter, layers, add external     no rapid warming or movement, no CPR             electrolytes only                       V,P or U, seizures, coma, death
heat (heat packs or hot water bottles)      (AED may be used). PPVs may be               3) Complete focused survey
                                            given.                                       4) Treat symptoms as indicated by           Electrolyte Sickness:
                                                                                             survey; continue to support cooling     A-, V, P or U; Hx of H2O but no food;
                                                                                             mechanisms                              can rapidly progress to ↑ICP
Patient SOAP Note                        Rescuer:                                            Past relevant medical Hx = relate to MOI
Patient Information           Name:
Age:                 Weight:                                  Male               Female
Address:                                                  Phone:                             Last food & fluids = intake & output
                                                          Date:                              H2O                               Calorie                               Electrolyte
                                                          Time:                              Urine color                       Urine output                          Stool
Contact:                                                  Phone:                             Events = Patient’s description of what happened                                 Amnesia Yes / No
Scene Size-Up:        Major Trauma            Environmental       Medical
Describe MOI

Describe Environmental Conditions
                                                                                                                     Objective Information = What you see
                                                                                             Physical Exam = look for discoloration, swelling, abnormal fluid loss & deformity. Feel for
Position Patient Found                   Initial Px           A V P U on arrival             tenderness, crepitus & instability. Check ROM and CSM.
R / L side        Front / back         No respirations   No pulse           Unstable spine      Time
Laying / Sitting / Standing           Severe Bleeding    Vomiting           Blocked Airway
Initial Tx

               Subjective Information = What the patient tells you
Symptoms = Describe onset, cause & severity (1-10) of chief complaints

Allergies = Local or systemic, cause, severity & Tx
                                                                                             Vital Signs = get a baseline, then record changes
                                                                                                Time         Pulse          Resp          BP                Skin          Temp             AVPU
Medications = Rx, OTC, herbal, homeopathic & recreational

Drug                          Reason                          Dose            Current
                                                                              Yes / No
                                                                              Yes / No
                      Assessment = What you think is wrong                                      Plan = what you are going to do
Possible Px                 Time    Current Px        Anticipated Px   Field Tx                                          Monitor
   ICP / Concussion
Respiratory Distress
Volume Shock
Unstable Spine
Trunk Injury
Unstable Extremity Injury
Stable Extremity Injury
Dehydration / Low Na
Hypothermia / Cold
Heat Stroke / Exhaustion
Frostbite / Burns
Local / Systemic Toxin
Local / Systemic Allergy
Near Drowning
Acute Mountain Sickness
Lightning Injuries
SCUBA / Free Diving
       Medical S/Sx
Circulatory                                                            Level 1 2 3 4
Respiratory                                                            GPS / Grid Coordinates
                                                                       Request ALS: Yes / No
Skin / Soft Tissue
Teeth / Gums
                               Additional Notes                                                     Radio Report

                                                                       Base, this is_______________________________with ______________
                                                                       I have a ________ year old male/female whose chief complaint is:______
                                                                       as a result of:________________________________________________
                                                                       Patient is currently A V P U and was found Laying/Sitting/Standing
                                                                       on R/L/Front/Back side. Patient exam revealed _____________________
                                                                       Spinal assessment revealed____________________________________
                                                                       Patient states _______________________________________________
                                                                       Initial vitals were: HR:_____ RR:_____ Skin:_____ BP:_____
                                                                       Current vitals are: HR:_____ RR:_____ Skin:______ BP:_____
                                                                       Treatments given are:_________________________________________
                                                                       Anticipated problems during transport are:_________________________
Additional vitals                                                      ___________________________________________________________
  Time          Pulse   Resp         BP           Skin   Temp   AVPU   ___________________________________________________________
                                                                       Evacuation priority is: 1 2 3 4
                                                                       We require: Litter / More People / Helicopter / ALS / _________________
                                                                       Our evacuation plan is ________________________________________
                                                                       Our GPS coordinates are:______________________________________
                                                                       LZ GPS coordinates are:_______________________________________

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