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Shock Edit

Spinal injuries Edit

Internal bleeding Edit

Sprains/soft tissue injury Edit

Heat exhaustion Edit

Hypothermia Edit

Treatment when outdoors:

  1. Take the casualty to a sheltered place as soon as possible. Shield the casualty from the wind.
  2. Remove and replace any wet clothing if possible; do not give them your clothes. Make sure the head is covered.
  3. Protect the casualty from the ground by using an insualting material like leaves/branches. Use anything to hand like a sleeping bag. Shelter with the casualty to warm them with your body heat.
  4. Call 99/112 or send for emergency help. It is important that the casualty is not left alone if you are in a group.
  5. Help to re-warm the casualty using warm drinks and high energy foods.
  6. The casualty must be re-warmed gradually. Monitor and record the casualty’s vital signs until help arrives

Treatment of hypothermia is largely based on rewarming, be it active or passive. Passive rewarming is ideal for previously healthy patients with mild hypothermia, this involves placing them in an insulated environment to minimize the normal mechanisms of heat loss.  In older patients, if rewarming is markedly prolonged (>12hrs) complications tend to arise. A good rule of thumb is to warm a patient no quicker than they cooled down in the first place.

Passive external rewarming is the most likely method to be implemented, however, metabolic heat generation is greatly reduced in hypothermic patients. It is less than 50% of normal below 28 degrees and shivering thermogenesis is extinguished below 32 degrees. In these cases active rewarming is required. This involved using either external heat sources applied to the trunk area, or delivering heat internally via heated air to breathe, warmed IV fluids, gastrointestinal irrigation etc. The latter are not possible in a wilderness setting.

The major danger with external warming is that it may cause peripheral blood vessels to dilate, diverting blood from the major organs. For the same reason, alcohol must never be given to a patient whom you suspect is hypothermic.

Remember that the neurological effects of hypothermia are profound. As the saying goes, a patient isn’t dead until they are warm and dead. In cold water immersion, if the head is kept above water, the heart can continue pumping for up to an hour after the casualty falls unconscious.

Hypoglycaemia Edit

Signs and symptoms:

  • History of diabetes - look for any identity bracelets etc. Patients with IDDM may recognise the onset of a hypo due to tingling lips etc.
  • Weakness, faintness or hunger
  • Confusion and irrational behavior
  • Sweating with cold, clammy skin. Rapid pulse.
  • Palpitations and muscle tremors
  • Deteriorating level of response (think GCS or AVPU)
  • Sweet smelling breath (ketones in diabetic ketoacidosis) - this requires urgent guided treatment with insulin

Treatment:

  • Sit the patient down and reduce exposure as much as possible.
  • If the patient has glucagon, administer it. Failing that, provide any sugary substance available. If the patient is unresponsive, rubbing jam or similar onto their gums can be enough to bring them round so that they can eat.

Anaphylaxis Edit

Basics

  • Anaphylaxis is a severe form of allergic reaction, & can be provoked by food, drugs, insect bits or stings.
  • Knowledge of the allergy is essential for cooks, expedition staff, and other group members.
  • Everyone should be aware of signs and symptoms, and know how to give adrenaline.

Preparation

  • People with a history of severe allergies should see their GP for advice before they go, and get a prescription for Epipens (ideally, as many as you can get). Piriton or similar antihistamines should also be carried.
  • You should ask for a letter from the GP explaining allergies and that you need to carry Epipens (useful for customs checks).
  • Known allergies must also be declared on medical/travel insurance, or you may invalidate your insurance and have to pay for your own treatment.
  • All group members should be made aware of the person’s allergy, as well as where the person’s Epipens are stored. If there are enough, I recommend splitting them up in case of loss of a bag etc.

Situation

  • While walking group has become a bit strung out, and you come across another group member sat down on the side of the trail who’s been sick and looks a bit faint.

Background

  • A couple of other group members have been stung in the last couple of days and this person confirms they were stung a few minutes ago. You remember they have a history of allergies. 
  • At this point, call for help from the rest of the group.

Assessment

  • Airway - swelling lips/tongue, hoarseness, stridor
  • Breathing - fast, shallow, wheeze, fatigue
  • Circulation - blue lips, pale, clammy, faint, drowsy
  • Also - hives, rashes

Recommendation

  • Call/Radio for help immediately, as the person may need evacuation.
  • Mild reaction - oral antihistamines like Piriton may suffice
  • Severe reaction
    • Lie patient flat and raise legs (low BP)
    • Adrenaline - most commonly Epipens (also Anapen, Jext), always read instructions! Normally remove cap, and press opposite end of pen into a muscular area (thigh/deltoid) until it clicks (note: don’t hold your thumb over the end, in case it’s the wrong way around). Hold for 10s, remove and massage area for 10s. Reassess and if no improvement in 5min, give second shot, but never try to re-use one. If a person recovers after adrenaline, they still need to go to hospital.

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