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This chapter should include specific as well as general first aid techniques written in a fashion to get the steps across quickly and clearly. Being vague in this section could be the difference between life and death. This chapter is of most concern legally and should be clearly stated that this is only a reference suggesting on last resort methods to sustain life until more qualified help can take over. It should be stressed throughout this chapter that calling 911 is the best course of action before attempting the methods contained within.
 

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Re: 2009 SCFJC Field Guide (6) First Aid

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First Aid
First aid is the provision of initial care for an illness or injury. It is usually performed by a lay person to a sick or injured patient until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of simple and, in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment.

Assessment and Diagnosis
*** Insert a brief description of Assessment and Diagnosis

Emergency Action Principals (EAP)
Use the Emergency Action Principles to get an accident situation under control quickly. These simple steps will help you take control of an emergency situation and treat immediate life-threatening problems in a safe, methodical manner. The objectives are to avoid injury to you while you are treating a life-threatening situation, to prevent further injury to the victim, and to get help on the way to the accident site if needed.

1) Survey the scene and determine if it is safe for you to work in.
2) Do a primary survey of the victim called the ABC’s, D & E:
a) Airway: Is it open? Minimize neck movement as much as possible; apply cervical collar if available.
b) Breathing: Is the victim breathing? Look, listen, feel. Rescue breathing if necessary.
c) Circulation: Is there a carotid pulse? Is there severe bleeding? CPR if necessary.
d) Disability: Is there injury to the nervous and musculoskeletal systems? Stabilize “C”-spine.
e) Exposure: Remove victim from offending environment. If necessary, place tent over victim.
Call 911 or radio for help: When you call for medical assistance, be prepared to give a brief description of the injury or illness and how and when it happened. Be prepared to offer up vital signs if asked. The following is the pertinent information that will be needed:

• Pulse rate: In an emergency, the best places to find the pulse are the carotid artery in the neck, or the femoral artery in the groin. In hypothermia cases, you should check for a minimum of one minute. Use the first three fingers to feel the pulse. Never use the thumb, which has a strong pulse of its own that can be mistaken for the patient’s pulse. If a patient has a severely injured extremity, record the presence or absence of a pulse beyond (distal to) the injury, and after alignment or splinting.
• Respiration rate: (Normal respiration rate is 12-20 per minute.) Look, listen, and feel for weak respirations. A light hand on the chest can detect the rise and fall of breathing, and will keep you “in touch” with the patient. In cases of High Altitude Pulmonary Edema (HAPE), those who are experienced in listening to lungs may hear “rales” (crackles) when pressing the ear tightly against the chest wall; a stethoscope isn’t necessary. They may be detected first by listening at the level of the right nipple, below the armpit. A cardboard toilet paper tube was used with success by a Field Safety Instructor to listen to and detect rales in a HAPE victim. Cheyne-Stokes respirations may occur during sleep; this is characterized by irregular breathing with pauses and gasps between breaths and are a sign that the body is not acclimated to the altitude, but it can also be a “normal” response to higher altitudes (approaching 10,000 feet pressure altitude).
• Blood Pressure: (Normal pressure is about 120/80, however, 90/50 to 140/90 may be normal for some people.) If you do not have a blood pressure cuff and you can detect a radial pulse (the pulse on the thumb side of the wrist, taken on an uninjured arm), the patient must have a systolic pulse (highest point of the blood pressure curve) of at least 90.
• Temperature: (Normal body temperature is around 98.6° F (37.0°C).) Body temperature usually is taken by placing the bulb of an oral thermometer under the tongue and leaving it in place, with the lips closed around it, for three minutes. A reading of 101.5° F or above signifies a fever and a reading below 95° F indicates hypothermia. Rectal temperatures are preferred for hypothermic or unconscious victims, but are difficult to obtain. Taking a rectal temperature requires a rectal thermometer, which are lower reading thermometers. The bulb of a rectal thermometer is shorter, wider, and rounder, and frequently, the top end of a rectal thermometer is flat.
• Level of consciousness: A patient with a normal level of consciousness is alert, oriented, talks coherently to the examiner, and can easily answer questions about identity, location, day, and time of day. Report any abnormal findings in mental status, verbal, and motor responses.
Important Note: The doctor may ask you for additional information regarding the victim’s condition. Following are five common signs that you may be asked to provide information on:
1. Skin temperature, moisture, and color: Examination of the skin furnishes important clues regarding oxygenation, general body stress, and the status of circulation to the skin. However, in dark-skinned people, skin pigment may mask color changes, and examination of the whites of the eyes or the nailbeds may be more reliable. Red skin can be a sign of high altitude problems or advanced carbon monoxide poisoning. Hypothermia may produce pale or bluish, cold, dry skin. Bluish skin (cyanosis) is a sign of inadequate oxygen in the blood. An illness or injury that stimulates a stress response from the sympathetic nervous system leading to increased heart rate and increased sweating is indicated by pale, clammy, cold skin.
2. Capillary refill: Using the thumb and forefinger, squeeze a finger or tip of toe until the nail blanches then release the pressure. The tissue under the nail should return to their normal pink color within two seconds.
3. Reaction of the pupils: The pupils are normally round and equal to each other in diameter. Unequal pupils (one pupil normal while the other is dilated) frequently indicates a serious injury involving the brain on the same side as the dilated pupil. However, it is normal for some individuals, so if you see it in a victim ask them if this is normal. The pupils are the “windows to the brain.” Patients who are in cardiac arrest generally have dilated pupils that do not constrict in response to bright light. The pupillary response to light is also lost after death.
4. Reaction to pain: Pinching the victim’s skin and asking “can you feel this?’’ should invoke a response of some sort. Inability to feel pain usually means damage to the nerve pathways.
5. Ability to move: To test for impaired movement, ask the patient to move his or her fingers and toes and to squeeze your hands. A conscious patient who is unable to comply is said to be “paralyzed.” The paralysis can involve a single extremity, one side of the body, or both sides of the body. Record exactly what the patient can or cannot do, and relay that information over the radio. Paralysis can be caused by severe injury without nerve damage if motion is so painful that the patient refuses to try to move.
Do a secondary survey of the victim: Interview the victim and /or companions, and conduct a thorough head-to-toe exam. Record the victim’s vital signs at regular intervals, with the date and time of each entry. If the patient is about to be transported, affix a piece of tape on the patient’s forehead with the most recent vital signs, date, and time recorded with an indelible marker.

Other Assessment and Diagnosis Tools
*** Insert a brief description of Other Assessment and Diagnosis

First Aid Treatment
*** Insert a brief description of First Aid

Allergic Reactions


Asthma
Asthma is a chronic disease involving the respiratory system in which the airways occasionally constrict, become inflamed, and are lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an environmental stimulant such as an allergen, environmental tobacco smoke, cold or warm air, perfume, pet dander, moist air, exercise or exertion, or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold. This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing. The airway constriction responds to bronchodilators. Between episodes, most patients feel well but can have mild symptoms and they may remain short of breath after exercise for longer periods of time than the unaffected individual. The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of drugs and environmental changes. Do not take cough medicine. These medicines do not help asthma and may cause unwanted side effects.
If someone is suffering from an asthma attack, ask them if they have medication with them. If they do, help them administer it then monitor them closely for changes. If the symptoms do not seem to be improving, call 911 or radio for help.
Tips:
• Aspirin and non-steroidal anti-inflammatory drugs, such as ibuprofen, can cause asthma to worsen in certain individuals. These medications should not be taken without the advice of your health care provider.
• Do not use nonprescription inhalers. These contain very short-acting drugs that may not last long enough to relieve an asthma attack and may cause unwanted side effects.
• Take only the medications your health care provider has prescribed for your asthma. Take them as directed.
• Do not take any nonprescription preparations, herbs, or dietary supplements, even if they are completely "natural," without talking to your health care provider first. Some of these may have unwanted side effects or interfere with your medications.
• If the medication is not working, do not take more than you have been directed to take. Overusing asthma medications can be dangerous.


Bites and Stings

Insect Bites and Stings
Insects inject formic acid, which can cause an immediate skin reaction often resulting in redness and swelling in the injured area. The sting from fire ants, bees, wasps and hornets are usually painful, and may stimulate dangerous allergic reaction called anaphylaxis for at-risk patients. Wasps can bite and sting at the same time. Bites from mosquitoes, fleas and mites are more likely to cause itching than pain.
Most reactions to insect bites are mild, causing little more than an annoying itching or stinging sensation and mild swelling that disappear within a day or so. A delayed reaction may cause fever, hives, painful joints and swollen glands. You might experience both the immediate and the delayed reactions from the same insect bite or sting. Only a small percentage of people develop severe reactions (anaphylaxis) to insect venom. Signs and symptoms of a severe reaction include:
• Facial swelling
• Difficulty breathing
• Abdominal pain
• Shock

Insect Bites and Stings Treatment
Bites from bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome. Bites from mosquitoes, ticks, biting flies and some spiders also can cause reactions, but these are generally milder.
1) For mild reactions
a) Move to a safe area to avoid more stings.
b) Scrape or brush off the stinger with a straight-edged object, such as a credit card or the back of a knife. Wash the affected area with soap and water. Don't try to pull out the stinger. Doing so may release more venom.
c) Apply a cold pack or cloth filled with ice to reduce pain and swelling.
d) Apply hydrocortisone cream (0.5 percent or 1 percent), calamine lotion or a baking soda paste — with a ratio of 3 teaspoons baking soda to 1 teaspoon water — to the bite or sting several times a day until your symptoms subside.
e) Take an antihistamine containing diphenhydramine (Benadryl, Tylenol Severe Allergy) or chlorpheniramine maleate (Chlor-Trimeton, Actifed). Allergic reactions may include mild nausea and intestinal cramps, diarrhea or swelling larger than 2 inches in diameter at the site. See your doctor promptly if you experience any of these signs and symptoms.
2) For severe reactions
a) Severe reactions may progress rapidly. Dial 911 or call for emergency medical assistance if the following signs or symptoms occur:
b) Difficulty breathing
c) Swelling of the lips or throat
d) Faintness
e) Dizziness
f) Confusion
g) Rapid heartbeat
h) Hives
i) Nausea, cramps and vomiting
Take these actions immediately while waiting with an affected person for medical help:
1) Check for special medications that the person might be carrying to treat an allergic attack, such as an auto-injector of epinephrine (for example, EpiPen). Administer the drug as directed — usually by pressing the auto-injector against the person's thigh and holding it in place for several seconds. Massage the injection site for 10 seconds to enhance absorption.
2) Have the person take an antihistamine pill if he or she is able to do so without choking, after administering epinephrine.
3) Have the person lie still on his or her back with feet higher than the head.
4) Loosen tight clothing and cover the person with a blanket. Don't give anything to drink.
5) Turn the person on his or her side to prevent choking, if there's vomiting or bleeding from the mouth.
6) Begin CPR, if there are no signs of circulation (breathing, coughing or movement).
7) If your doctor has prescribed an auto-injector of epinephrine, read the instructions before a problem develops and also have your household members read them.

Snake Bites
Snake bites can be deadly. It's important to react quickly to bites. If emergency medical services can be reached, request help through 911. If in a remote area, getting the victim to medical care is vital.
North America is home to several different species of venomous snakes. The most common is the rattlesnake. Antivenin is available, but it must be used as early as possible.
1) Safety first! Get away from the snake. That's probably why it bit in the first place. Follow universal precautions and wear personal protective equipment if you have it.
2) Call 911 immediately! Waiting until the pain may lead to permanent tissue damage. Remember that calling 911 on a cell phone is different than a regular phone.
3) Do not elevate. Keep the bite below the level of the heart.
4) Wash the area with warm water and soap.
5) Remove constricting clothing and jewelry from the extremity. The area may swell and constricting items will cause tissue death.
6) If the snake is an elapid species (coral snakes and cobras), wrap the extremity with an elastic pressure bandage. Start from the point closest to the heart and wrap towards the fingers or toes. Continue to keep the bite lower than the heart.
7) Follow the basics of first aid while waiting for responders to arrive. Be especially concerned about the potential for shock.
Tips:
NO CUTTING & SUCKING! Those snake bite kits from the drug store don't work. Cutting into the wound will just create infections.
If the snake is dead, bringing it to the hospital is appropriate. Be careful, dead snakes can reflexively bite for up to an hour.
In today's digital world, pictures are easy to get. A quick picture of the snake - even with a cell phone - will help medical crews identify the animal. Rattlesnakes are pit vipers, identified by dents in the side of their heads that look like ears. Coral snakes are small with bands of red bordered by pale yellow or white. Cobras have hoods that spread behind their heads.
It's not that important to identify the snake; medical crews in areas prone to snake bites can often identify the animal just from the wound. Pit vipers have two fangs and the bite often has two small holes (see illustration). Coral snakes have small mouths full of teeth with rows of small puncture wounds.

Animal Bites
If an animal bites you or your child, follow these guidelines:
1) For minor wounds. If the bite barely breaks the skin and there is no danger of rabies, treat it as a minor wound. Wash the wound thoroughly with soap and water. Apply an antibiotic cream to prevent infection and cover the bite with a clean bandage.
2) For deep wounds. If the animal bite creates a deep puncture of the skin or the skin is badly torn and bleeding, apply pressure with a clean, dry cloth to stop the bleeding and see your doctor.
3) For infection. If you notice signs of infection, such as swelling, redness, increased pain or oozing, see your doctor immediately.
4) For suspected rabies. If you suspect the bite was caused by an animal that might carry rabies — including any wild or domestic animal of unknown immunization status — see your doctor immediately.
Doctors recommend getting a tetanus shot every 10 years. If your last one was more than five years ago and your wound is deep or dirty, your doctor may recommend a booster. You should have the booster within 48 hours of the injury.

Domestic pets cause most animal bites. Dogs are more likely to bite than cats are. Cat bites, however, are more likely to cause infection. Bites from nonimmunized domestic animals and wild animals carry the risk of rabies. Rabies is more common in raccoons, skunks, bats and foxes than in cats and dogs. Rabbits, squirrels and other rodents rarely carry rabies.



Bleeding
Bleeding can occur from various injuries such as cuts, punctures, scratches, abrasions and dry skin. Allowing the wound to bleed some will self clean it by forcing impurities out of the wound. The bleeding should then be stopped using direct pressure, elevation and in some cases, time. After the bleeding has stopped, irrigating the wound or cleansing the wound with a gentle soap and water will reduce the chance of a bacterial infection. Depending on the severity of the wound and the intended type of closure, an antibiotic ointment can be applied to the inside of the wound to further reduce infection. Closure of the wound can then be performed using any number of applications from a band-Aid to Super-Glue.

Bleeding Treatment
1. Bleed the Wound
a. Allowing some blood to flow after being injured can be a good thing as it will naturally clean the wound by forcing contaminants out. Use common sense, a little bleeding is OK, no more than ½ cup.

2. Stop the Bleeding
a. Elevation - Keeping the wound above the level of the heart will decrease the pressure at the point of injury, and will reduce the bleeding. This mainly applies to limbs and the head, as it is impractical (and in some cases damaging) to attempt to move the torso around to achieve this. Most protocols also do not use elevation on limbs which are broken, as this may exacerbate the injury.
b. Direct Pressure - Placing pressure on the wound will constrict the blood vessels manually, helping to stem any blood flow. When applying pressure, the type and direction of the wound may have an effect, for instance, a cut lengthways on the hand would be opened up by closing the hand in to a fist, whilst a cut across the hand would be sealed by making a fist. A patient can apply pressure directly to their own wound, if their consciousness level allows. Ideally a barrier, such as sterile, low-adherent gauze should be used between the pressure supplier and the wound, to help reduce chances of infection and help the wound to seal. Third parties assisting a patient are always advised to use protective latex or nitrile medical gloves to reduce risk of infection or contamination passing either way. Direct pressure can be used with some foreign objects protruding from a wound, and to achieve this, padding is applied from either side of the object to push in and seal the wound - objects are never removed.
c. Presure Points - In situations where direct pressure and elevation are either not possible or proving ineffective, and there is a risk of exsanguination, some training protocols advocate the use of pressure points to constrict the major artery which feeds the point of the bleed. This is usually performed at a place where a pulse can be found, such as in the femoral artery. There are significant risks involved in performing pressure point constriction, including necrosis of the area below the constriction, and most protocols give a maximum time for constriction (often around 10 minutes). There is particularly high danger if constricting the carotid artery in the neck, as the brain is sensitive to hypoxia and brain damage can result within minutes of application of pressure. Pressure on the Carotid artery can also cause vagal tone induced bradycardia, which can eventually stop the heart. Other dangers in use of a constricting method include rhabdomyolysis, which is a build up of toxins below the pressure point, which if released back in to the main bloodstream may cause renal failure
i. Epistaxis – or a nosebleed is a special case, where almost all first aid providers train the use of pressure points. The appropriate point here is on the soft fleshy part of the nose, which should constrict the capillaries sufficiently to stop bleeding, although obviously, this will not stop bleeding which originates in the nasopharynx or the tear ducts
d. Tourniquets - Another method of achieving constriction of the supplying artery is via the use of a tourniquet - a tightly tied band which goes around a limb to restrict blood flow. Tourniquets are routinely used in order to bring veins to the surface for cannulation, although their use in emergency medicine is more limited, and is restricted in most countries (with France being a notable exception) to professionals such as physicians and paramedics, as this is often considered beyond the reach of first aid and those acting in good faith as a good samaritan. A key exception is the military, where many armies carry a tourniquet as part of their personal first aid kit. Most Police in Australia are also authorized to apply a tourniquet to bleeding victims, which is often the case if they arrive onsite before ambulance personnel do. This is reflective of the higher chance of receiving massive trauma (such as amputation) and the increased time involved in reaching definitive care.

Improvised tourniquets, however, usually fail to achieve force enough to compress the arteries of the limb and thus do not only fail to stop arterial bleeding but actually increase bleeding due to the impaired venous blood flow. Some argue that tourniquets should never be used in the pre-hospital setting, not even for amputations. Evidence from mine-infested areas also show a higher mortality for mine victims treated with tourniquets pre-hospitaly. An emergency tourniquet should in any case never be applied to the forearm or lower leg since the arteries in these locations run between bones and can not be compressed.
3. Cleanse the Wound
a. Soap and Water – Start by washing the area surrounding the wound with a mild soap and water to remove dirt and crusted blood.
b. Irrigation – Next, irrigate the wound using a syringe with saline solution or flush with clean water to remove contamination inside the wound.
4. Reduce Infection
a. Antibiotic Ointment – Carefully apply some antibiotic ointment inside the wound prior to closure to help reduce a bacterial infection. Be careful not to allow excess ointment onto the clean skin on the edge of the wound as it might interfere with the following closure techniques.
5. Close the Wound
a. Band-Aid –
b. Closure Strips –
c. Super-Glue – For wounds that are less than one inch deep, use Super-Glue to permanently close the wound. Holding the wound closed, apply a bead of Super-Glue along the seam of the wound opening and hold together for 3 minutes before releasing to check for closure. Wipe and remove excess blood and add another bead of Super-Glue if necessary until the wound has been successfully closed.

Broken Bones
A fracture is a broken bone. It requires medical attention. If the broken bone is the result of major trauma or injury, call 911 or radio for help. Also call for emergency help if:
• The person is unresponsive, isn't breathing or isn't moving. Begin cardiopulmonary resuscitation (CPR) if there's no respiration or heartbeat.
• There is heavy bleeding.
• Even gentle pressure or movement causes pain.
• The limb or joint appears deformed.
• The bone has pierced the skin.
• The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip.
• You suspect a bone is broken in the neck, head or back.
• You suspect a bone is broken in the hip, pelvis or upper leg (for example, the leg and foot turn outward abnormally).
Take these actions immediately while waiting for medical help:
1. Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.
2. Immobilize the injured area. Don't try to realign the bone, but if you've been trained in how to splint and professional help isn't readily available, apply a splint to the area.
3. Apply ice packs to limit swelling and help relieve pain until emergency personnel arrive. Don't apply ice directly to the skin — wrap the ice in a towel, piece of cloth or some other material.
4. Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.


Bruises


Burns


Chest Pain


Choking
Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, a piece of food often is the culprit. Young children often swallow small objects. Because choking cuts off oxygen to the brain, administer first aid as quickly as possible.
The universal sign for choking is hands clutched to the throat. If the person doesn't give the signal, look for these indications:
• Inability to talk
• Difficulty breathing or noisy breathing
• Inability to cough forcefully
• Skin, lips and nails turning blue or dusky
• Loss of consciousness
If choking is occurring, the Red Cross recommends a "five-and-five" approach to delivering first aid:
1. First, deliver five back blows between the person's shoulder blades with the heel of your hand.
2. Next, perform five abdominal thrusts (also known as the Heimlich maneuver).
3. Alternate between five back blows and five abdominal thrusts until the blockage is dislodged.
4. If you're the only rescuer, perform back blows and abdominal thrusts before calling 911 (or your local emergency number) for help. If another person is available, have that person call for help while you perform first aid.
To perform abdominal thrusts (Heimlich maneuver) on someone else:
1. Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
2. Make a fist with one hand. Position it slightly above the person's navel.
3. Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
4. Perform a total of five abdominal thrusts, if needed. If the blockage still isn't dislodged, repeat the "five-and-five" cycle.
If you're alone and choking, you'll be unable to effectively deliver back blows to yourself. However, you can still perform abdominal thrusts to dislodge the item.
To perform abdominal thrusts (Heimlich maneuver) on yourself:
1. Place a fist slightly above your navel.
2. Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
3. Shove your fist inward and upward.
Clearing the airway of a pregnant woman or obese person:
1. Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.
2. Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust.
3. Repeat until the food or other blockage is dislodged or the person becomes unconscious.
Clearing the airway of an unconscious person:
1. Lower the person on his or her back onto the floor.
2. Clear the airway. If there's a visible blockage at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Be careful not to push the food or object deeper into the airway, which can happen easily in young children.
3. Begin cardiopulmonary resuscitation (CPR) if the object remains lodged and the person doesn't respond after you take the above measures. The chest compressions used in CPR may dislodge the object. Remember to recheck the mouth periodically.
Clearing the airway of a choking infant younger than age 1:
1. Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh.
2. Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object.
3. Hold the infant faceup on your forearm with the head lower than the trunk if the above doesn't work. Using two fingers placed at the center of the infant's breastbone, give five quick chest compressions.
4. Repeat the back blows and chest thrusts if breathing doesn't resume. Call for emergency medical help.
5. Begin infant CPR if one of these techniques opens the airway but the infant doesn't resume breathing.
6. If the child is older than age 1, give abdominal thrusts only.
To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course.
CPR (Cardio Pulmonary Resuscitation)
Stay Safe! The worst thing a rescuer can do is become another victim. Follow universal precautions and wear personal protective equipment if you have it. Use common sense and stay away from potential hazards.
1. Attempt to wake victim. Briskly rub your knuckles against the victim's sternum. If the victim does not wake, call 911 or radio for help and proceed to step 3. If the victim wakes, moans, or moves, then CPR is not necessary at this time. Call 911 or radio for help if the victim is confused or not able to speak.
2. Begin rescue breathing:
a. Open the victim's airway using the head-tilt, chin-lift method. Put your ear to the victim's open mouth:
b. look for chest movement
c. listen for air flowing through the mouth or nose
d. feel for air on your cheek
e. If there is no breathing, pinch the victim's nose; make a seal over the victim's mouth with yours. Use a CPR mask if available. Give the victim a breath big enough to make the chest rise. Let the chest fall, and then repeat the rescue breath once more.
3. Begin chest compressions. Place the heel of your hand in the middle of the victim's chest. Put your other hand on top of the first with your fingers interlaced. Compress the chest about 1-1/2 to 2 inches (4-5 cm). Allow the chest to completely recoil before the next compression. Compress the chest at a rate equal to 100/minute. Perform 30 compressions at this rate.
4. Repeat rescue breaths. Open the airway with head-tilt, chin-lift again. This time, go directly to rescue breaths without checking for breathing again. Give one breath, making sure the chest rises and falls, then give another.
5. Perform 30 more chest compressions. Repeat steps 5 and 6 for about two minutes.
6. Stop compressions and recheck victim for breathing. If the victim is not breathing, continue chest compressions and rescue breaths.
7. Keep going until help arrives.
Tips:
If you have access to an automated external defibrillator, attach it to the victim after approximately one minute of CPR (chest compressions and rescue breaths).
Chest compressions are extremely important. If you are not comfortable giving rescue breaths, still perform chest compressions!
It's normal to feel pops and snaps when you first begin chest compressions - DON'T STOP! You aren't going to make the victim any worse. Cardiac arrest is as bad as it gets.
When performing chest compressions, do not let your hands bounce. Let the chest fully recoil, but keep the heel of your hand in contact with the sternum at all times.

Diarrhea



Dizziness



Drug Overdose



Eye Injury



Fainting



Fever



Food Poisoning



Foreign Objects



Frostbite
Frostbite is the freezing of body tissue. Frostnip of your nose, cheeks and ears can be prevented by using the buddy system. Watch your partners and tell them if you see blanched, frozen skin on their faces. When red cheeks and noses become white, cover up! Just by turning one’s face out of the wind and covering up the affected skin, you can often cure the problem. If your extremities are cold enough to freeze, you might be getting hypothermic, which is life threatening. Polypropylene glove liners work wonders for protecting fingers from cold metal instruments, cameras, etc. The hands, feet, ears, cheeks, and nose are all located far from the heart at the periphery of the body and are subject to rapid heat loss because of their large surface area-to-volume ratio and their exposed positions. Other factors that contribute to frostbite include inadequate insulation, wet clothing, fatigue, poor nutrition, alcohol, tobacco, restricted peripheral circulation (because of tight clothing or equipment), and contact with metal or hydrocarbon liquids such as gasoline. Frostbite often develops during periods of severe environmental stress when facilities for proper emergency care are nonexistent, and the party’s main concern is to escape alive.

Superficial Frostbite: Superficial frostbite, often called frostnip, feels like a mild tingling or pain followed by numbness. Inspection reveals a gray or yellowish patch of skin, usually on the nose, ear, cheek, finger, or toe. The tissues beneath the area remain soft and pliable.

Treatment of Superficial Frostbite: Apply direct body heat, e.g., by placing a warm hand on a frozen cheek, nose, earlobe, or holding a frozen finger in an armpit, feet on a warm stomach. The first-aider should consider why frostbite occurred; the patient should add clothing and seek shelter.

Deep Frostbite: Deep frostbite is a full- or partial thickness freezing of a body part that mainly affects the hands and feet. It should be suspected if a painfully cold part suddenly stops hurting when the part obviously is not getting warmer. The affected part is cold, solid and wooden with pale, waxy skin; it resembles a piece of chicken just removed from the freezer. Experience has shown that the amount of permanent tissue damage depends on both how low the temperature is and how long the body part is frozen; rapid re-warming causes less damage that slow re-warming.

Treatment of Deep Frostbite: The proper emergency care for deep frostbite is rapid re-warming in a water bath with the water temperature carefully controlled between 102°and 108°F (39° to 42°C). Cooler water re-warms too slowly; warmer water may burn the tissues. Re-warming should be done only in a shelter where the patient’s entire body can be kept warm. The rescuer will need a high-registering thermometer and a vessel large enough so that the extremity can be immersed without touching the sides of the vessel. A 20-quart pot is the minimum size needed for re-warming a foot. As a rule, re-warming continues for 20 to 30 minutes or until the frozen areas turn a deep red or bluish color and the color change has progressed distally as far as it will go. As the water bath cools, remove the extremity, add hot water, stir, and retest the water temperature before re-immersing the extremity. Re-warming usually causes severe pain. While the frozen part is being re-warmed, maintain the patient’s morale with hot drinks and apply heat to non-frozen body parts to open up circulation to the frozen area. Be aware that the victim will experience some discomfort during the re-warming process, pain medications may be warranted. Protect a thawed limb against refreezing, infection, and trauma by applying thick layers of sterile dressings held in place by a loosely applied, self-adhering roller bandage. Leave blisters unopened, separate digits with soft cotton or wool pads, and elevate the part to reduce swelling. Exercise judgment in deciding whether to re-warm a frozen extremity in the field. Do not attempt re-warming if there is any chance that the extremity may refreeze. Field re-warming is indicated if there is a good chance that the part will thaw spontaneously during evacuation. However, if the patient cannot be kept warm or cannot be carried out, it is permissible to let the patient walk or ski out on a frozen foot. Care must be taken to keep the foot frozen until it can be rapidly re-warmed under suitable conditions. This has been shown to cause less permanent damage than allowing the part to slowly thaw during transport. Patients frequently become aware of a frozen part because of the pain that accompanies thawing. Depending on the size and isolation of the party, there may be no alternative to self-evacuation on the thawed foot. If that is the case, refreezing should be prevented at all costs because it often leads to gangrene.

Head Injuries



Heart Attack


Hypothermia
Hypothermia is the lowering of the body core temperature and can occur from a number of different types of situations. Personnel must be aware that hypothermia can result from exposure to cold rain and high wind, and from falling into cold water. In other field locations where rain is not an issue, hypothermia is still a threat because it is simply a lowering of the core temperature. When it drops and the downward trend is not stopped, the patient will eventually die. Prevention is the key. Proper layering of clothing, adequate food, and sufficient hydration are key elements in avoiding hypothermia. It is critical to recognize the signs and symptoms of mild hypothermia, so as to stop its progression to profound (severe) hypothermia. If the body-core temperature drops, the body will sacrifice the arms and legs to keep warm blood around the vital organs: brain, heart, lungs, kidneys, and liver. That is called shunting. The warm blood is decreased to the limbs. It is difficult to recognize in oneself. If you are having a hard time working your hands (such as difficulty tying your boot laces), your body core is cooling down. Most hypothermic victims deny that they are having trouble. You must take action.
• Signs and Symptoms of Hypothermia
o Difficulty working hands
o Shivering
o Stumbling
o Bumbling
o Withdrawn and grumpy attitude
o Denial
Treatment of Hypothermia: The first priority is to prevent further heat loss by getting the patient out of the wind (and snow, and water) and into a tent or other shelter. The patient should be given dry clothing and put into a sleeping bag, if available. If a sleeping bag is unavailable, put spare clothing under and over the patient and cover the patient’s head. Avoid unnecessary handling and do not allow the patient to sit, stand, or walk until he or she is re-warmed. It may be better to cut off wet clothing than to undress the patient; if no dry clothing is available, wrap the patient in a tarp, space blanket, plastic sheeting, or similar material to reduce evaporative cooling. It is more effective to “package” the victim in a “hypothermia wrap” than to lay with the victim in two bags zipped together. Hypothermia wrap: Remove damp clothing from victim. Dress victim in dry synthetic underwear, balaclava, neck gaiter. Wrap victim in a vapor barrier such as a space blanket, plastic tarp, etc. Place victim in sleeping bag. The more bags the better. Place hot water bottles (wrapped in a sock to avoid burns) on victim’s trunk, armpits, groin area. Insulate the head and neck with extra sweaters, jackets, etc. Place another vapor barrier around the outside of the sleeping bags. Further emergency care depends on the patient’s measured or estimated core temperature. If a thermometer is unavailable, the patient can be considered to have a core temperature above 90° F (32° C) if he or she is still shivering and capable of appropriate actions such as zipping an open parka and picking up a dropped mitten. The core temperature is very likely below 90° F if the patient is no longer shivering and especially if he or she has become stuporous or comatose.

Mild Hypothermia: A hypothermic patient whose rectal temperature is 90°F (32°C) or above can be re-warmed by any means available; these means will be limited under field conditions.

Profound Hypothermia: The mortality rate outside a hospital is high for patients who have a rectal temperature below 90° F (32°C). In-hospital survival is better because medical personnel can discover, monitor and rapidly treat metabolic and electrolyte problems, and re-warm the patient under controlled conditions. Patients with profound hypothermia may appear to be dead because their pulses and respirations are so difficult to detect. Spend a minute or longer attempting to detect both vital signs before concluding that they are absent. The motto “No one is dead until warm and dead” emphasizes that all patients with hypothermia deserve an attempt at re-warming.

Low Blood Sugar



Neck & Back Injuries



Poisoning
Carbon Monoxide Poisoning
Carbon monoxide poisoning is fairly common. It can be a significant hazard in extreme cold environments, particularly when stoves are used in poorly ventilated shelters such as tents, snow caves, and igloos. Many people have been killed or narrowly escaped death from carbon monoxide poisoning caused by operating stoves in tightly closed areas. Carbon monoxide is a colorless, odorless gas that is produced by incomplete combustion of carbon-containing substances. Dangerously high levels of carbon monoxide can form whenever fuel is burned in a poorly ventilated space. When inhaled, carbon monoxide combines with the hemoglobin in red blood cells and renders the cells incapable of carrying oxygen. Even a very low concentration of carbon monoxide (0.06%) is enough to block one half of all hemoglobin available to transport oxygen. Carbon monoxide also combines with cellular enzymes and causes tissue damage, particularly in the heart and brain. The signs and symptoms depend on the amount of carbon monoxide the patient has inhaled. In mild cases, the patient may complain of dizziness, headache, and confusion. Fatigue, numbness, chest pains, heart palpitations, and visual disturbances may also be present. Severe cases may manifest as a deep coma. Many experts feel that some effects attributed to acute mountain sickness may, in fact, be caused by carbon monoxide. Carbon monoxide poisoning is also frequently misdiagnosed as migraine, stroke, alcohol intoxication, heart disease, food poisoning, and psychiatric illness. Recognizing this insidious condition may be difficult when all members of the party are affected. Carbon monoxide is eliminated from the body very slowly under normal conditions, and it continues to cause tissue damage as long as it is present. Victims of carbon monoxide poisoning may suffer neurological complications a few days to three weeks after exposure, and as late as two years after apparent complete recovery. These complications include memory impairment and personality change, and they may be permanent. Carbon monoxide poisoning should be taken very seriously.

Treatment of Carbon Monoxide Poisoning: Victims should be immediately removed from the contaminated area. To hasten the elimination of carbon monoxide, all victims should be provided with 100% oxygen, no matter how slight or apparently inconsequential their symptoms. The oxygen should be administered via a securely sealing mask and a demand valve. (Other methods of administration, such as nasal cannula, do not deliver 100% oxygen.) Severely affected patients may require rescue breathing (with oxygen) and should be evacuated to an appropriate medical facility. Hyperbaric oxygen treatment greatly increases the rate of carbon monoxide elimination and speeds recovery. Further, the late term neurological complications described above have not been reported in people treated with hyperbaric oxygen.

Seizures



Shock



Sprains & Strains



Sunburn



Vomiting



Choking
 

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Re: 2009 SCFJC Field Guide (6) First Aid

Same as the other chapters, here is something to get us started. Can someone review these items and pare them down a bit?


Title:
First Aid

Subtitle:
First aid is the provision of initial care for an illness or injury. It is usually performed by a lay person to a sick or injured patient until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of simple and, in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment.

Heading 1:
Emergency Action Principals (EAP)

Heading 1 Body:
Use the Emergency Action Principles to get an accident situation under control quickly. These simple steps will help you take control of an emergency situation and treat immediate life-threatening problems in a safe, methodical manner. The objectives are to avoid injury to you while you are treating a life-threatening situation, to prevent further injury to the victim, and to get help on the way to the accident site if needed.

Survey the scene and determine if it is safe for you to work in.

Do a primary survey of the victim called the ABC’s, D & E:
• Airway: Is it open? Minimize neck movement as much as possible; apply cervical collar if available.
• Breathing: Is the victim breathing? Look, listen, feel. Rescue breathing if necessary.
• Circulation: Is there a carotid pulse? Is there severe bleeding? CPR if necessary.
• Disability: Is there injury to the nervous and musculoskeletal systems? Stabilize “C”-spine.
• Exposure: Remove victim from offending environment. If necessary, place tent over victim.

Phone or radio for medical assistance: When you call for medical assistance, be prepared to give a brief description of the injury or illness and how and when it happened. Be prepared to offer up vital signs if asked. The following is the pertinent information that will be needed:

• Pulse rate: In an emergency, the best places to find the pulse are the carotid artery in the neck, or the femoral artery in the groin. In hypothermia cases, you should check for a minimum of one minute. Use the first three fingers to feel the pulse. Never use the thumb, which has a strong pulse of its own that can be mistaken for the patient’s pulse. If a patient has a severely injured extremity, record the presence or absence of a pulse beyond (distal to) the injury, and after alignment or splinting.

• Respiration rate: (Normal respiration rate is 12-20 per minute.) Look, listen, and feel for weak respirations. A light hand on the chest can detect the rise and fall of breathing, and will keep you “in touch” with the patient. In cases of High Altitude Pulmonary Edema (HAPE), those who are experienced in listening to lungs may hear “rales” (crackles) when pressing the ear tightly against the chest wall; a stethoscope isn’t necessary. They may be detected first by listening at the level of the right nipple, below the armpit. A cardboard toilet paper tube was used with success by a Field Safety Instructor to listen to and detect rales in a HAPE victim. Cheyne-Stokes respirations may occur during sleep; this is characterized by irregular breathing with pauses and gasps between breaths and are a sign that the body is not acclimated to the altitude, but it can also be a “normal” response to higher altitudes (approaching 10,000 feet pressure altitude).

• Blood Pressure: (Normal is pressure is about 120/80, however, 90/50 to 140/90 may be normal for some people.) If you do not have a blood pressure cuff and you can detect a radial pulse (the pulse on the thumb side of the wrist, taken on an uninjured arm), the patient must have a systolic pulse (highest point of the blood pressure curve) of at least 90.

• Temperature: (Normal body temperature is around 98.6° F (37.0°C).) Body temperature usually is taken by placing the bulb of an oral thermometer under the tongue and leaving it in place, with the lips closed around it, for three minutes. A reading of 101.5° F or above signifies a fever and a reading below 95° F indicates hypothermia. Rectal temperatures are preferred for hypothermic or unconscious victims, but are difficult to obtain. Taking a rectal temperature requires a rectal thermometer, which are lower reading thermometers. The bulb of a rectal thermometer is shorter, wider, and rounder, and frequently, the top end of a rectal thermometer is flat.

• Level of consciousness: A patient with a normal level of consciousness is alert, oriented, talks coherently to the examiner, and can easily answer questions about identity, location, day, and time of day. Report any abnormal findings in mental status, verbal, and motor responses.

Important Note: The doctor may ask you for additional information regarding the victim’s condition. Following are five common signs that you may be asked to provide information on:

1) Skin temperature, moisture, and color: Examination of the skin furnishes important clues regarding oxygenation, general body stress, and the status of circulation to the skin. However, in dark-skinned people, skin pigment may mask color changes, and examination of the whites of the eyes or the nailbeds may be more reliable. Red skin can be a sign of high altitude problems or advanced carbon monoxide poisoning. Hypothermia may produce pale or bluish, cold, dry skin. Bluish skin (cyanosis) is a sign of inadequate oxygen in the blood. An illness or injury that stimulates a stress response from the sympathetic nervous system leading to increased heart rate and increased sweating is indicated by pale, clammy, cold skin.

2) Capillary refill: Using the thumb and forefinger, squeeze a finger or tip of toe until the nail blanches, then release the pressure. The tissue under the nail should return to their normal pink color within two seconds.

3) Reaction of the pupils: The pupils are normally round and equal to each other in diameter. Unequal pupils (one pupil normal while the other is dilated) frequently indicates a serious injury involving the brain on the same side as the dilated pupil. However, it is normal for some individuals, so if you see it in a victim ask them if this is normal. The pupils are the “windows to the brain.” Patients who are in cardiac arrest generally have dilated pupils that do not constrict in response to bright light. The pupillary response to light is also lost after death.

4) Reaction to pain: Pinching the victim’s skin and asking “can you feel this?’’ should invoke a response of some sort. Inability to feel pain usually means damage to the nerve pathways.

5) Ability to move: To test for impaired movement, ask the patient to move his or her fingers and toes and to squeeze your hands. A conscious patient who is unable to comply is said to be “paralyzed.” The paralysis can involve a single extremity, one side of the body, or both sides of the body. Record exactly what the patient can or cannot do, and relay that information over the radio. Paralysis can be caused by severe injury without nerve damage if motion is so painful that the patient refuses to try to move.

Do a secondary survey of the victim: Interview the victim and /or companions, and conduct a thorough head-to-toe exam. Record the victim’s vital signs at regular intervals, with the date and time of each entry. If the patient is about to be transported, affix a piece of tape on the patient’s forehead with the most recent vital signs, date, and time recorded with an indelible marker.


Heading 1:
First Aid

Heading 2:
Frostbite

Frostbite is the freezing of body tissue. Frostnip of your nose, cheeks and ears can be prevented by using the buddy system. Watch your partners and tell them if you see blanched, frozen skin on their faces. When red cheeks and noses become white, cover up! Just by turning one’s face out of the wind and covering up the affected skin, you can often cure the problem. If your extremities are cold enough to freeze, you might be getting hypothermic, which is life threatening. Polypropylene glove liners work wonders for protecting fingers from cold metal instruments, cameras, etc. The hands, feet, ears, cheeks, and nose are all located far from the heart at the periphery of the body and are subject to rapid heat loss because of their large surfacearea-to-volume ratio and their exposed positions. Other factors that contribute to frostbite include inadequate insulation, wet clothing, fatigue, poor nutrition, alcohol, tobacco, restricted peripheral circulation (because of tight clothing or equipment), and contact with metal or hydrocarbon liquids such as gasoline. Frostbite often develops during periods of severe environmental stress when facilities for proper emergency care are nonexistent, and the party’s main concern is to escape alive.

Superficial Frostbite: Superficial frostbite, often called frostnip, feels like a mild tingling or pain followed by numbness. Inspection reveals a gray or yellowish
patch of skin, usually on the nose, ear, cheek, finger, or toe. The tissues beneath the area remain soft and pliable.

Treatment of Superficial Frostbite: Apply direct body heat, e.g., by placing a warm hand on a frozen cheek, nose, earlobe, or holding a frozen finger in an armpit, feet on a warm stomach. The first-aider should consider why frostbite occurred; the patient should add clothing and seek shelter.

Deep Frostbite: Deep frostbite is a full- or partialthickness freezing of a body part that mainly affects the hands and feet. It should be suspected if a painfully cold part suddenly stops hurting when the part obviously is not getting warmer. The affected part is cold, solid and wooden with pale, waxy skin; it resembles a piece of chicken just removed from the freezer. Experience has shown that the amount of permanent tissue damage depends on both how low the temperature is and how long the body part is frozen; rapid rewarming causes less damage that slow rewarming.

Treatment of Deep Frostbite: The proper emergency care for deep frostbite is rapid rewarming in a water bath with the water temperature carefully controlled between 102°and 108°F (39° to 42°C). Cooler water rewarms too slowly; warmer water may burn the tissues. Rewarming should be done only in a shelter where the patient’s entire body can be kept warm. The rescuer will need a high-registering thermometer and a vessel large enough so that the extremity can be immersed without touching the sides of the vessel. A 20-quart pot is the minimum size needed for rewarming a foot. As a rule, rewarming continues for 20 to 30 minutes or until the frozen areas turn a deep red or bluish color and the color change has progressed distally as far as it will go. As the water bath cools, remove the extremity, add hot water, stir, and retest the water temperature before reimmersing the extremity. Rewarming usually causes severe pain. While the frozen part is being rewarmed, maintain the patient’s morale with hot drinks and apply heat to nonfrozen body parts to open up circulation to the frozen area. Be aware that the victim will experience some discomfort during the rewarming process, pain medications may be warranted. Protect a thawed limb against refreezing, infection, and trauma by applying thick layers of sterile dressings held in place by a loosely applied, self-adhering roller bandage. Leave blisters unopened, separate digits with soft cotton or wool pads, and elevate the part to reduce swelling. Exercise judgment in deciding whether to rewarm a frozen extremity in the field. Do not attempt rewarming if there is any chance that the extremity may refreeze. Field rewarming is indicated if there is a good chance that the part will thaw spontaneously during evacuation. However, if the patient cannot be kept warm or cannot be carried out, it is permissible to let the patient walk or ski out on a frozen foot. Care must be taken to keep the foot frozen until it can be rapidly rewarmed under suitable conditions. This has been shown to cause less permanent damage than allowing the part to slowly thaw during transport. Patients frequently become aware of a frozen part because of the pain that accompanies thawing. Depending on the size and isolation of the party, there may be no alternative to self-evacuation on the thawed foot. If that is the case, refreezing should be prevented at all costs because it often leads to gangrene.


Heading2:
Hypothermia

Heading 2 Body:
Hypothermia is the lowering of the body core temperature and can occur from a number of different types of situations. Personnel must be aware that hypothermia can result from exposure to cold rain and high wind, and from falling into cold water. In other field locations where rain is not an issue, hypothermia is still a threat because it is simply a lowering of the core temperature. When it drops and the downward trend is not stopped, the patient will eventually die. Prevention is the key. Proper layering of clothing, adequate food, and sufficient hydration are key elements in avoiding hypothermia. It is critical to recognize the signs and symptoms of mild hypothermia, so as to stop its progression to profound (severe) hypothermia. If the body-core temperature drops, the body will sacrifice the arms and legs to keep warm blood around the vital organs: brain, heart, lungs, kidneys, and liver. That is called shunting. The warm blood is decreased to the limbs. It is difficult to recognize in oneself. If you are having a hard time working your hands (such as difficulty tying your boot laces), your body core is cooling down. Most hypothermic victims deny that they are having trouble. You must take action.

Signs and Symptoms of Hypothermia
• Difficulty working hands
• Shivering
• Stumbling
• Bumbling
• Withdrawn and grumpy attitude
• Denial

Treatment of Hypothermia: The first priority is to prevent further heat loss by getting the patient out of the wind (and snow, and water) and into a tent or other shelter. The patient should be given dry clothing and put into a sleeping bag, if available. If a sleeping bag is unavailable, put spare clothing under and over the patient and cover the patient’s head. Avoid unnecessary handling and do not allow the patient to sit, stand, or walk until he or she is rewarmed. It may be better to cut off wet clothing than to undress the patient; if no dry clothing is available, wrap the patient in a tarp, space blanket, plastic sheeting, or similar material to reduce evaporative cooling. It is more effective to “package” the victim in a “hypothermia wrap” than to lay with the victim in two bags zipped together. Hypothermia wrap: Remove damp clothing from victim. Dress victim in dry synthetic underwear, balaclava, neck gaiter. Wrap victim in a vapor barrier such as a space blanket, plastic tarp, etc. Place victim in sleeping bag. The more bags the better. Place hot water bottles (wrapped in a sock to avoid burns) on victim’s trunk, armpits, groin area. Insulate the head and neck with extra sweaters, jackets, etc. Place another vapor barrier around the outside of the sleeping bags. Further emergency care depends on the patient’s measured or estimated core temperature. If a thermometer is unavailable, the patient can be considered to have a core temperature above 90° F (32° C) if he or she is still shivering and capable of appropriate actions such as zipping an open parka and picking up a dropped mitten. The core temperature is very likely below 90° F if the patient is no longer shivering and especially if he or she has become stuporous or comatose.

Mild Hypothermia: A hypothermic patient whose rectal temperature is 90°F (32°C) or above can be rewarmed by any means available; these means will be limited under field conditions.

Profound Hypothermia: The mortality rate outside a hospital is high for patients who have a rectal temperature below 90° F (32°C). In-hospital survival is better because medical personnel can discover, monitor and rapidly treat metabolic and electrolyte problems, and rewarm the patient under controlled conditions. Patients with profound hypothermia may appear to be dead because their pulses and respirations are so difficult to detect. Spend a minute or longer attempting to detect both vital signs before concluding that they are absent. The motto “No one is dead until warm and dead” emphasizes that all patients with hypothermia deserve an attempt at rewarming.

Heading 2:
Carbon Monoxide Poisoning

Heading 2 Body:
Carbon monoxide poisoning is fairly common. It can be a significant hazard in the Antarctic environment, particularly when stoves are used in poorly ventilated shelters such as tents, snow caves, and igloos. Many polar explorers have been killed or narrowly escaped death from carbon monoxide poisoning caused by operating stoves in tightly closed areas. Carbon monoxide is a colorless, odorless gas that is produced by incomplete combustion of carbon-containing substances. Dangerously high levels of carbon monoxide can form whenever fuel is burned in a poorly ventilated space. When inhaled, carbon monoxide combines with the hemoglobin in red blood cells and renders the cells incapable of carrying oxygen. Even a very low concentration of carbon monoxide (0.06%) is enough to block one half of all hemoglobin available to transport oxygen. Carbon monoxide also combines with cellular enzymes and causes tissue damage, particularly in the heart and brain. The signs and symptoms depend on the amount of carbon monoxide the patient has inhaled. In mild cases, the patient may complain of dizziness, headache, and confusion. Fatigue, numbness, chest pains, heart palpitations, and visual disturbances may also be present. Severe cases may manifest as a deep coma. Many experts feel that some effects attributed to acute mountain sickness may, in fact, be caused by carbon monoxide. Carbon monoxide poisoning is also frequently misdiagnosed as migraine, stroke, alcohol intoxication, heart disease, food poisoning, and psychiatric illness. Recognizing this insidious condition may be difficult when all members of the party are affected. Carbon monoxide is eliminated from the body very slowly under normal conditions, and it continues to cause tissue damage as long as it is present. Victims of carbon monoxide poisoning may suffer neurological complications a few days to three weeks after exposure, and as late as two years after apparent complete recovery. These complications include memory impairment and personality change, and they may be permanent. Carbon monoxide poisoning should be taken very
seriously.

Treatment of Carbon Monoxide Poisoning: Victims should be immediately removed from the contaminated area. To hasten the elimination of carbon monoxide, all victims should be provided with 100% oxygen, no matter how slight or apparently inconsequential their symptoms. The oxygen should be administered via a securely sealing mask and a demand valve. (Other methods of administration, such as nasal cannula, do not deliver 100% oxygen.) Severely affected patients may require rescue breathing (with oxygen) and should be evacuated to an appropriate medical facility. Hyperbaric oxygen treatment greatly increases the rate of carbon monoxide elimination and speeds recovery. Further, the late term neurological complications described above have not been reported in people treated with hyperbaric oxygen.

Heading 2:
Wounds

Heading 2 Body:
Ouch, i have a cut ;)

Heading 2:
Burns

Heading 2 Body:
Ouch, i burned myself ;)

Heading 2:
Broken Bones

Heading 2 Body:
DOAH! i broke me skeleton ;)

Heading 2:
Choking

Heading 2 Body:
..... ;)

Heading 2:
Bites

Heading 2 Body:
owie! i got bit by a snake, rabid coyote and a black widow ;)
 

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Discussion Starter · #5 ·
Re: 2009 SCFJC Field Guide (6) First Aid

Possible legal disclaimer to be used. please post up your thoughts:

Disclaimer: This information is not intended as a substitute for professional medical advice, emergency treatment or formal first-aid training. Don't use this information to diagnose or develop a treatment plan for a health problem or disease without consulting a qualified health care provider. If you're in a life-threatening or emergency medical situation, seek medical assistance immediately.
 

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Discussion Starter · #6 ·
All,

I'd really like to get this chapter of the Field Guide completed but I lack the medical training and experiences to properly complete it. Is their someone out there willing to take what's been done and modify / add info to complete it?

For an explaination of what the Field Guide is, please see this: http://www.socalfjcruiserforums.com/forums/showthread.php?t=1181

Thanks!
 

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All,

I'd really like to get this chapter of the Field Guide completed but I lack the medical training and experiences to properly complete it. Is their someone out there willing to take what's been done and modify / add info to complete it?

For an explaination of what the Field Guide is, please see this: http://www.socalfjcruiserforums.com/forums/showthread.php?t=1181

Thanks!
I might be able to add a few things. While it's been some time since I've had to use it, I did get my EMT a few years ago (which reminds me, I need a refresher). I still have the material in a box somewhere. I'll dig it out and find the relevant information.
 

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I am a US Navy Field Corpsman (Medic) and i just got back from afghanistan about a week ago, i know some of you and as you know Off-Roading is my #1 hobbie and im back now so if you have any questions on gear to bring out to the trail or stories that i cant share online just ask me. I plan on being on the trail almost everytime you guys go out and i always carry my Medical Bag with me no matter what. Point blank im here for you guys
 

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Along with JBird, Im a fireman / paramedic. I don't mind going over some of this stuff and revising and or condensing. let me have some time with it and ill get back to you all!
 

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same with me, when i get some time ill go over it and submit any chages or updates, as most may know that CPR chages all the time lol, i feel that out of all the guides this is a very important one to have because out in the field it can mean life or death in knowing what to do

Along with JBird, Im a fireman / paramedic. I don't mind going over some of this stuff and revising and or condensing. let me have some time with it and ill get back to you all!
 

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sorry i never got to write anything but if anyone has questions im here with a new name because seems like i lost the password to my other one and cant seen to unlock it, i will also take pictures of my med bag for long and short trips and explain everything
 
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