WILDERNESS MEDICINE

J AY V E E S G U E R R E R O M D
EMERGENCY MEDICINE PHYSICIAN
OVERVIEW

• What is wilderness medicine?

• How did it begin?
• What does it encompass?
• Why should I participate?
W H AT I S

• Wilderness: “a tract or region

uncultivated and uninhabited
by human beings”

• Medical care in a non-medical

setting
• Requires broad knowledge
• Encourages adaptation and
HOW DID IT BEGIN

• In the mid-1970s physicians and guides started meeting to discuss “Mountain

Medicine” topics.

• The Wilderness Medical Society was formed in 1983.

• In 1990 the first edition of Wilderness & Environmental Medicine was published.

• Wilderness medicine interest has grown every year.

• Wilderness medicine has expanded to sub-specialty areas.
Includes aspects of:
•Mountain Medicine
•Disaster Medicine
•Marine Medicine
•Tactical Medicine
•Tropical Medicine
•International Travel
•Search and Rescue
 WILDERNESS TRAUMA

A LT I T U D E D I S O R D E R

COLD INJURIES AND HYPOTHERMIA

E M E R G E N C Y A I R W AY S

E V A C U AT I O N T E C H N I Q U E S

DIVE MEDICINE

LIGHTNING INJURY

P L A N T T O X I N A N D D E R M AT I T I S

E N V E N O M AT I O N
 WHY SHOULD YOU
PA R T I C I PAT E

• To become a well-rounded
physician
• To get a broader perspective of
medicine
• To contribute to an emerging field
of medicine
• To “Combine your profession with
your passion”
• Wilderness Medicine is a broad field offering countless exciting
opportunities.
• There are multiple ways to get involved.
• Wilderness medicine training helps all physicians.
• Get out there and have fun.
WILDERNESS FIRST AID COURSE
PAT I E N T A S S E S S M E N T S Y S T E M ( PA S )

scene size up
SCENE SIZE UP
PAT I E N T A S S E S S M E N T S Y S T E M ( PA S )

Size-up the scene

1.Survey the scene for hazards:

3. Protect yourself from bodily
* Immediate danger to rescuers substances (BSI).

* Immediate danger to bystanders 4. Determine the number of

patients.
* Immediate danger to patients
5. Form a general impression of the
2. Determine what e have caused patient.
the accident or injury (MOI).
PAT I E N T A S S E S S M E N T S Y S T E M ( PA S )

scene size up

initial assessment R-ABCDE

INITIAL ASSESSMENT R-ABCDE

Survey the patient for immediate threats to life

1. Identify yourself and your level of training. Obtain consent to treat.

2. Establish responsiveness. Assess for verbal or pain response and if the mechanism warrants, stabilize the
spine.

3. Airway management: Look in the patient's mouth. Clear any obstructions.

4. Breathing adequacy: Look, listen, and feel. Expose chest injuries.

5. Circulation: Assess for pulse. Control life-threatening bleeding.

6. Disability: If there is any chance that the patient has a spine injury, maintain manual stabilization of the spine.

7. Environment/Expose: Assess and treat environmental life-threats. Expose any serious wounds.
PAT I E N T A S S E S S M E N T S Y S T E M ( PA S )

scene size up

initial assessment R-ABCDE

history
PE sample history secondary survey
SECONDARY SURVEY

Patient Exam

o Complete a head to toe assessment: Look, ask, feel, and listen.

Vital Signs: Note/time taken

o Level of Responsiveness

o Heart Rate, Rhythm and Quality

o Respiratory Rate, Rhythm and Quality

o Skin Color, Temperature and Moisture

SECONDARY SURVEY

Patient History:

o Chief Complaint
o Pertinent medical history
o Cause of the injury or illness (MOI)
o Last intake/output
o Symptoms
o Events preceding the incident or
illness
o Allergies

o Medications
PAT I E N T A S S E S S M E N T S Y S T E M ( PA S )

scene size up

initial assessment R-ABCDE

secondary survey

problem list and plans

PAT I E N T A S S E S S M E N T S Y S T E M ( PA S )

scene size up

initial assessment R-ABCDE

secondary survey

problem list and plans

monitoring
 Altered Mental Status
To STOP
TO TOXIN

S SUGAR/SEIZURE

T T E M P E R AT U R E

O OXYGEN

P PRESSURE
TOXINS
SUGAR/SEIZURE
Temperature
OXYGEN

PRESSURE
 SPINAL INJURIES
• Signs and Symptoms

* Pain, tenderness or obvious injury along the

vertebral column

* Altered extremity sensations e.g., numbness,

tingling unusual hot or cold sensations

* Weakness or paralysis

* Respiratory difficulty

* Loss of bowel or bladder control

* Signs and symptoms of shock

 SPINAL INJURIES
Treatment Principles

1. Stabilize the spine and control the head manually.

E V A C U AT I O N G U I D E L I N E S
2. Check circulation, sensation and motion (CSM) in the extremities. S U M M A R Y: S P I N E I N J U R Y

3. Establish neutral alignment of the spine. • E V A C U AT E A N Y PAT I E N T B E I N G

T R E AT E D F O R P O S S I B L E S P I N A L
4. Apply a cervical collar.
I N J U R Y.
5. BEAM or log-roll the patient onto a pad and protect her or him from
• R A P I D LY E V A C U AT E A N Y PAT I E N T
the environment.
WITH SIGNS OR SYMPTOMS OF
6. Maintain head stabilization throughout. S P I N A L C O R D I N J U R Y.

7. Recheck CSM in the extremities.

8. Evacuate. Ideally, utilize a commercial spinal immobilization device

rather than an improvised litter.
SPINE INJURIES

• Focused Spine Assessment For patients with a potential for spine injury and
without signs or symptoms of spine injury.

• 1. Reliable patient: sober, not distracted

• 2. Normal CSM in all four extremities: * Circulation (warm, pink digits or good
pulse at wrists) * Sensation (no numbness, tingling or unusual hot or cold
sensations * Motion (unless otherwise explainable by another injury or illness)

• 3. The patient must deny spinal pain and tenderness. If the patient meets all the
above criteria, a decision to discontinue spinal immobilization can be made.
SHOCK
bp? sensorium?
bleeding?
pulses?
laboratory?

definition of shock:
inadequate supply of oxygen rich blood to the brain and other organs
SHOCK

M I L D / C O M P E N S AT O R Y

INCREASED HR
S E R I O U S / D E C O M P E N S AT O R Y
INCREASED RR

WEAK PULSES
A D E Q U AT E O 2 S U P P LY
TO THE BRAIN
A LT E R E D S E N S O R I U M

NO DECREASE IN
SENSORIUM
T R E AT M E N T P R I N C I P L E S S H O C K

E A R LY R E C O G N I T I O N A N D T R E AT M E N T

F I N D C A U S E O F S H O C K . K E E P PAT I E N T C A L M

E L E V AT E E X T R E M I T I E S

O R A L F L U I D S I F T O L E R AT E D

M O N I T O R PAT I E N T

E V A C U AT E
HYPOTHERMIA

MILD M O D E R AT E SEVERE

SHIVERING VIOLENT SHIVERING SHIVERING STOPS

CONFUSION MUSCULAR RIGIDITY

SLUGGISHNESS STUPOR

SLURRED SPEECH UNRESPONSIVENESS

STUMBLING DECREASING RR AND

PULSES
TREATMENT PRINCIPLE FOR MILD/MODERATE HYPOTHERMIA

CHANGE ENVIRONMENT
TREATMENT PRINCIPLE FOR MILD/MODERATE HYPOTHERMIA

INSULATE PATIENT
T R E AT M E N T P R I N C I P L E S FOR SEVERE
HYPOTHERMIA

• Assist breathing for 5-10mins prior to movement

• hypothermia wrap with field warming (if feasible) and evacuate

• heat packs at hands, feet armpits groin and neck

FROSTBITE AND NON FREEZING COLD INJURY

FROSTBITE NON
FREEZING COLD
INJURY

LOCAL FREEZING C H R O N I C A L LY C O L D
I N J U R Y R E S U LT I N G T O BUT NOT FROZEN
EXTENSIVE TISSUE
DAMAGE ( + ) PA I N
T R E AT M E N T

• Avoid refreezing

• if not frozen • if frozen :

• never massage
: warm the warm bath
or use radiant
injury (skin- 37-39 C
heat
to-skin)
• Give NSAIDS
H E AT I N J U R I E S
H E AT I N J U R I E S T R E AT M E N T P R I N C I P L E

AGRESSIVE COOLING
REST IN A COOL PLACE

S P R AY PAT I E N T W I T H
REPLACE FLUID LOSSES
W AT E R
MONITOR SENSORIUM
E V A C U AT E R A P I D LY
ANAPHYLAXIS

flushing
SWELLING systemic
SHOCK
hives life-threatening
allergic reaction R E S P I R AT O R Y D I S T R E S S
difficulty of breathing
itchiness of skin
histamine
T R E AT M E N T P R I N C I P L E S

R E M O V E T H E A L L E R G E N O R R E M O V E T H E PAT I E N T
FROM THE ENVIRONMENT

EPINEPHRINE 0.3ML (1:1000) IM

E V A C U AT E I M M E D I AT E LY
“prepping isn’t crazy. its common sense.”

prepping for Talomo-Apo

A LT I T U D E I L L N E S S

INSUFFICIENT OXYGEN IN THE BLOOD CAUSED BY

D E C R E A S E D AT M O S P H E R I C P R E S S U R E AT H I G H A LT I T U D E

A C U T E M O U N TA I N S I C K N E S S
H E A D A C H E C O M M O N LY A C C O M PA N I E D B Y O N E O R M O R E
OF THE FOLLOWING SYMPTOMS:

* NAUSEA VOMITING
* LOSS OF APPETITE
* W E A K N E S S AT R E S T O R F AT I G U E
* INSOMIA
T R E AT M E N T

• STOP ASCENT UNTIL SIGNS AND SYMPTOMS RESOLVED

• DESCEND IF DOESNT RESOLVE

• DESCEND IMMEDIATELY IF NOTED WITH SEVERE ALTITUDE ILLNESS

• EVACUATION PLAN:

• IMMEDIATELY DESCENT 600 TO 1200M IF ONSET OF SEVERE ALTITUDE

ILNESS
WILDERNESS MEDICINE

THANK YOU