10/27 Wilderness Medicine Wednesday
Happy Wednesday everyone! Today’s blog post is going to continue with the theme of improvising medical supplies “in the field”, we will be talking about the split. As many of you know, splints are used to stabilize sprains and fractures in our limbs. The point of a splint is to immobilize the joint to prevent further damage. With something like an ankle sprain we want the joint immobilized for obvious reasons, because it hurts to move it. With fractures, like a broken arm we want to immobilize the joints connected to the bone because as those joints move, the bone will too, which is obviously not good. If you take nothing else away from this post remember: we always want to immobilize the joint above AND below whatever we are splinting.
In making a splint there’s a few things we always want to keep in mind and we actually have an acronym to help us. RAFT, which stands for Rigid, Adjustable, Fluffy, and Tight. We want the splint to have at least one rigid object in it, like a stick to provide support to the broken bone, or sprained joint so that it does not move. The splint needs to be adjustable so that it does not cut off circulation (like a torniquet). The easiest way to check this is test the patient’s capillary refill. What you want to do is squeeze the patient’s fingers or toes (obviously the ones connected to the limb the splint is on) and the blood should flow back into the area and color will return rather quickly. If this process doesn’t happen, or is slow (compare it to the other hand/foot) then the splint needs to be loosened. Never put the “rigid” part of a splint right up against someone’s skin. We want the splint to be fluffy to make it more comfortable for the patient and provide some protection in case it gets bumped during evacuation. Sweaters and jackets are great for this purpose. Finally, we want the splint to be tight so that the joints do not move. A common mistake with splints is that they are not tight enough to actually immobilize the joint(s). A working knowledge of simple knots like the trucker hitch and carrying paracord are really useful for this purpose. See the video below for an example of how to make a split. I hope this post was useful to you guys, thanks for reading and have a great week!
10/13 Wilderness Medicine Wednesday
By Coach Nick
Happy Wednesday everyone! I hope you are all having a good week and enjoying the first snow of the year! In the spirit of some cold weather moving in we are going to be talking about frostbite today.
As most of you probably know, frostbite is a condition that develops at the far extreme of cold injuries. Frostbite itself is the actual freezing of the skin tissue on our bodies. It is most likely to develop in areas with less blood flow such as our fingers, toes, and exposed parts of the face like our cheeks or nose. The most severe form of frostbite occurs when the skin is fully frozen and the cells fully freeze and burst, unfortunately there is no coming back from this form of frostbite. Fortunately, there are several degrees of frostbite that occur before this point that are recognizable and treatable. The differing degrees of frostbite are: superficial, partial thickness, and full thickness which I will discuss independently in more detail below.
Superficial frostbite is the most common and one that a lot of us who enjoy winter activities may be familiar with. As localized areas of the body are getting extremely cold the body will begin to restrict blood flow to the area in a process known as vasoconstriction. This is why it becomes harder to move your fingers and toes when they get really cold. The easiest way to recognize superficial frostbite is that the area will be cold, numb, and pale but the skin will still appear soft. At this point the tissue is not frozen but it is still damaged and if not treated will progress to more severe forms of frostbite. The industry standard is to re-warm the area within 6 hours. The best way to safely rewarm the tissue is through skin to skin contact in warm areas of the body like the groin or the armpits, this can be done with the patient themselves or other members of the group. Keep in mind that the patient is also at risk of hypothermia at this point so it may be best for another member of the group to help rather than place a patient’s cold hands in their armpits. It’s important not to rub the area or apply any sort of aggressive measure in reheating as this can cause further damage to the cells (this is true for all stages of frostbite). Also, do not use anything hot (water, flame, etc) to rewarm as the patient will not be able to feel when they are being burned which can cause a new set of problems.
The next form of frostbite is partial thickness which is when we need to start becoming a little more worried. This stage of frostbite is defined by the actual formation of ice crystals in the tissue. The skin will appear largely similar to superficial frostbite with the addition of the formation of fluid or blood filled blisters. The patient will also experience pretty intense pain when thawing the area. The good news is that the treatment for partial thickness frostbite is largely the same as superficial frostbite. The only exception is that it’s critical to cover any blisters that may form and DO NOT try to puncture and drain them. At this stage of frostbite the patient needs to be evacuated. Also, once this point is reached the skin is pretty damaged and the patient is at extreme risk of developing frostbite again and much more quickly so you should take extra measures to prevent it during evacuation.
The final stage of frostbite, and one you hopefully never see or experience, is full thickness frostbite. This condition is characterized by the full freezing of the skin, tissue, tendons, and nerves. The tissue will be numb, white, and hard to the touch which indicates that the area is fully frozen and the tissue is destroyed. The major difference here is that we should never attempt to re-warm the tissue in the field as the patient needs higher level medical attention to properly re-warm. When the tissue at this point is re-warmed too quickly the area will release dangerous quantities of proteins that can cause fever and renal failure which we obviously don’t want in the field. Also, at this point when the tissue is re-warmed it becomes useless and unable to be used. In the field, while it would be extremely painful, a patient can still walk on fully frostbitten feet, if they are re-warmed the patient will not be able to walk and will need to be carried. Obviously at this point evacuation is critical, the faster the patient can be evacuated the better chance they have of saving the tissue.
As you can see there are some common themes in treating frostbite. We always need to keep in mind that the patient at an elevated risk of hypothermia so we need to take measures to treat that at the same time. It’s important not to get sucked into just treating the frostbite and forgetting about other potential problems. In an effort to be proactive make sure to be constantly checking yourself and other members of your group to recognize frostbite before it develops. Wet clothing and exposed skin are the biggest risk factors for frostbite, addressing these issues will prevent frostbite entirely in most cases.
As always, I hope none of you ever have to experience this but if the situation does arise I hope this post was helpful!
10/6 Wilderness Medicine Wednesday
By Coach Nick
Happy Wednesday everyone, I hope you are all enjoying this week! Today’s post is a sort of continuation from last week’s post about patient carrying. Today we are going to be talking about spinal injuries, specifically when to take what we call “spine precautions”. The reason for this line of thinking is if we are with someone who is injured in the wilderness we want a checklist of sorts to decide whether or not they may have injured their spine. If we decide that the possibility exists we need to think about how we can immobilize their spine so that we don’t hurt them even more. I will talk a little bit about how to do this at the end.
There’s a few things to look for and think about when determining whether or not to take spine precautions. Here we are looking for some specific mechanisms of injury that would indicate a possible spinal injury. The specific ones we are looking for are: diving injuries, fall from 3 times the patients height or higher, tumbling fall, fast moving accident (skiing, car, etc.), direct blow to the spine, gunshot wound, or lightning. This list is not all inclusive, but it is a good checklist to go through. If any of these things happen to someone in your group it’s critical to stabilize their spine no matter what they are saying or how they are acting. Be careful of what we call distracting injures. This is when another injury is so bad that it could be distracting you or the patient from the fact that they may have a broken spine. An example of this would be a compound fracture sustained from a skiing accident. Another important thing to watch for is what we call Battle’s Sign. This manifests itself in bruising behind the patient’s ears and is typical in head trauma injuries. If you see this it’s a quick clue to go into spine precautions.
Once you make the decision to apply spine precautions there’s a few important things to remember. First, it’s important to calm the patient down and make them realize the importance of not trying to move. While you’re doing this cradle their head in your hands by putting your index fingers under their ears and the rest of your hand supporting their neck and jaw with your thumbs above their ears. It’s crucial that you don’t release this hold until you put on what’s called a C-collar. While this is happening have some members of your group try and construct a litter for evacuation that will be as stable as possible (this is only if there’s no hope of rescue or getting real equipment like a backboard). The only time you should move a patient during this process is in an emergency (like an avalanche coming your way) or to prevent hypothermia. Next, we need to make what’s called a C-collar so that we can let go of their head without risking damage to their neck. I doubt any of you carry a real C-collar with you on outdoor trips so I have attached a video of how to make one. On that note, if you’re into activities with a high risk of spinal injury like back country skiing or whitewater kayaking it might be a good idea to have someone in your group carry a real C-collar.
At this level of care I’m not going to go into the process of clearing the spine and allowing someone to move around again after a suspected spinal injury. For our purposes the important thing is to be able to recognize significant mechanisms of injury and know how to stabilize that patient. Remember, in the wilderness we are always going to be walking the line between the “textbook” medical care and what we need to do to survive and evacuate. Being able to recognize potential spine injury and knowing how to stabilize it could be enough to save a friend from paralysis or even death. I know this is a pretty heavy topic but I think it’s important for you guys to know and understand. Simple actions here can make a huge difference and don’t require a lot of medical background to apply. As always, I hope none of you ever have to apply this knowledge but if you do some day I hope this helps!
9/29 Wilderness Medicine Wednesday
by Coach Nick
Hello everyone! I hope you guys have been getting outside and enjoying the transition into fall weather and the lack of smoke around town! Today’s Wilderness Medicine Wednesday post is going to be about moving patients that are injured. Rather than try to write a bunch of descriptions I will show you some videos that hopefully make a little more sense. I want to go over three useful types of patient moves and show you some examples via video. Some of these moves may sound a little unorthodox but we need to remember that we are approaching this from the perspective of being in the wilderness.
The first type of move is going to be the emergency move. There’s no video for this one because it’s extremely simple. We are going to grab the patient and get them out of harm’s way as quickly as possible. We would use this in a scenario where the patient’s life is in immediate danger like they were lying in the path of an avalanche, drowning in a river, or had just been attacked by a bear. We want to execute this move when there’s no doubt that their life is in danger. This may feel a little unorthodox especially when we have a concern about the patient’s spine. As you may know when someone suffers a spinal injury (or we suspect they have, I’ll talk about this next week) they need to be moved very carefully in order to not risk additional injury, especially paralysis. When their life is on the line such as one of the above scenarios, we are going to basically ignore this risk and get them to safety. That’s the emergency move.
Another type of move is called the BEAM method. You need at least 5-6 people or more to pull this off but it’s very useful especially over short distances. The video below demonstrated the BEAM method. A note on this one: this is not considered a stable move for patients with spinal injuries however it can be used in some scenarios. If you want to do this and think the patient may have a spinal injury make sure to take special care in immobilizing the head and neck. The next carry I’ll show you is the only one we will consider “safe” for spinal injuries in the wilderness. One thing to note from this video is the guy in the grey shirt holding the patient’s head is in charge. This is always the case in wilderness medicine especially when carrying patients.
The last type of move I want to go over is the litter carry. This move is necessary when the patient can’t walk on their own and you don’t want to carry them out on your back or by some other ridiculous method. Also, this is ALWAYS the method we will use when we suspect spinal injuries. On that note, as you watch the video you may think “that doesn’t look super safe for a broken spine”. I agree, this is only to be used for spinal injuries if there’s no hope of a medical team with other equipment coming to you. If you’re waiting for search and rescue and it’s not a life or death situation don’t carry someone with a broken spine like this. Also, you may notice that the people in this video use some materials that you may not always carry. That’s okay. The important part of building litters is improvisation, this video shows you the basic structure of how one should work. I will say that if you don’t carry a tarp with you, you should. They are crucial for carrying patients, building shelters, collecting materials, and a lot of other things.
I hope you guys enjoyed this post! Have a great week everyone!
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