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Troop 158
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Hypothermia The basic principles of rewarming a hypothermic victim are to conserve the heat they have and replace the body fuel they are burning up to generate that heat. If a person is shivering, they have the ability to rewarm themselves at a rate of 2 degrees C per hour. Mild - Moderate Hypothermia 1. Reduce Heat Loss b. Food intake c. Things to avoid 3. Add Heat * Fire or other external heat source Severe Hypothermia 1. Reduce Heat Loss * Hypothermia Wrap: The idea is to provide a shell of total insulation for the patient. No matter how cold, patients can still internally rewarm themselves much more efficiently than any external rewarming. Make sure the patient is dry, and has a polypropylene layer to minimize sweating on the skin. The person must be protected from any moisture in the environment. Use multiple sleeping bags, wool blankets, wool clothing, Ensolite pads to create a minimum of 4" of insulation all the way around the patient, especially between the patient and the ground. Include an aluminum "space" blanket to help prevent radiant heat loss, and wrap the entire ensemble in plastic to protect from wind and water. If someone is truly hypothermic, don't put him/her naked in a sleeping bag with another person. 2. Add Fuel & Fluids * Warm Sugar Water - for people in severe hypothermia, the stomach has shut down and will not digest solid food but can absorb water and sugars. Give a dilute mixture of warm water with sugar every 15 minutes. Dilute Jello™ works best since it is part sugar and part protein. This will be absorbed directly into the blood stream providing the necessary calories to allow the person to rewarm themselves. One box of Jello = 500 Kilocalories of heat energy. Do not give full strength Jello even in liquid form, it is too concentrated and will not be absorbed. * Urination - people will have to urinate from cold diuresis. Vasoconstriction creates greater volume pressure in the blood stream. The kidneys pull off excess fluid to reduce the pressure. A full bladder results in body heat being used to keep urine warm rather than vital organs. Once the person has urinated, precious body heat will be used to maintain the temperature of vital organs. So in the end urinating will help conserve heat. You will need to help the person urinate. Open up the Hypothermia Wrap enough to do this and then cover them back up. You will need to keep them hydrated with the dilute Jello solution described above. 3. Add Heat Heat can be applied to transfer heat to major arteries - at the neck for the carotid, at the armpits for the brachial, at the groin for the femoral, at the palms of the hands for the arterial arch. * Chemical heat packs such as the Heat Wave™ provides
110 degrees F for 6-10 hours. Afterdrop is a situation in which the core temperature actually decreases during rewarming. This is caused by peripheral vessels in the arms and legs dilating if they are rewarmed. This dilation sends this very cold, stagnate blood from the periphery to the core further decreasing core temperature which can lead to death. In addition, this blood also is very acetic which may lead to cardiac arrythmias and death.
Afterdrop can best be avoided by not rewarming the periphery. Rewarm the core only! Do not expose a severely hypothermic victim to extremes of heat.
CPR & Hypothermia
When a person is in severe hypothermia they may demonstrate all the accepted clinical signs of death: * Cold But they still may be alive in a "metabolic icebox" and can be revived. You job as a rescuer is to rewarm the person and do CPR if indicated. A hypothermia victim is never cold and dead only warm and dead. During severe hypothermia the heart is hyperexcitable and mechanical stimulation (such as CPR, moving them or Afterdrop) may result in fibrillation leading to death. As a result CPR may be contraindicated for some hypothermia situations: 1. Make sure you do a complete assessment of heart rate before beginning CPR. Remember, the heart rate may be 2-3/minute and the breathing rate 1/30 seconds. Instituting cardiac compressions at this point may lead to life-threatening arrythmias. Check the carotid pulse for a longer time period (up to a minute) to ascertain if there is some slow heartbeat. Also, even though the heart is beating very slowly, it is filling completely and distributing blood fairly effectively. External cardiac compressions only are 20-30% effective. Thus, with its severely decreased demands, the body may be able to satisfy its circulatory needs with only 2-3 beats per minute. Be sure the pulse is absent before beginning CPR. You will need to continue to do CPR as you rewarm the person. 2. Ventilation may have stopped but respiration may continue - the oxygen demands for the body have been so diminished with hypothermia that the body may be able to survive for some time using only the oxygen that is already in the body. If ventilation has stopped, artificial ventilation may be started to increase available oxygen. In addition, blowing warm air into the persons lungs may assist in internal rewarming. 3. CPR Procedures * Check radial pulse, between 91.4 and 86 degrees F
this pulse disappears Heat Stroke is one of the few life threatening medical emergencies. A victim can die within minutes if not properly treated. Heat Stroke is caused by an increase in the body's core temperature. Core temperatures over 105° (41° C) can lead to death. The rate of onset of Heat Stroke depends on the individual's fluid status. To understand Heat Stroke think of that same car pulling a trailer up a mountain pass on a hot day. This time the radiator has plenty of flu d, but the heat challenge of the engine combined with the external temperature is too much. The engine can't great rid of the heat fast enough and the engine overheats. There are two types of Heat Stroke-fluid depleted (slow onset) and fluid intact (fast onset). * Fluid depleted - The person has Heat Exhaustion due to fluid loss from sweating and/or inadequate fluid replacement, but continues to function in a heat challenge situation. Ultimately, the lack of fluid has minimized the body's active heat loss capabilities to such an extent that the internal core temperature begins to rise. Example: a cyclist on a hot day with limited water. * Fluid intact (fast onset) - The person is under an extreme heat challenge. The heat challenge overwhelms the body's active heat loss mechanisms even though the fluid level is sufficient. Example: a cyclist pushing hard on a 104 deg F day (40 deg C). Signs & Symptoms of Heat Stroke * The key to identifying Heat Stroke is hot skin. Some
victims may have hot, dry skin, others may have hot, wet skin because they have
just moved from Heat Exhaustion to Heat Stroke. Heat Stroke Treatment * Efforts to reduce body temperature must begin
immediately! Move the patient (gently) to a cooler spot or shade the victim.
Remove clothing. Pour water on the extremities and fan the person to increase
air circulation and evaporation. Or cover the extremities with cool wet cloths
and fan the patient. Immersion in cool (not cold) water is also useful. During
cooling the extremities should be massaged vigorously to help propel the cooled
blood back into the core. This occurs when fluid losses from sweating and respiration are greater than internal fluid reserves (volume depletion). Heat Exhaustion is really a form of volume shock. The lack of fluid causes the body to constrict blood vessels especially in the periphery (arms and legs). To understand Heat Exhaustion think of a car with a radiator leak pulling a trailer up a mountain pass. There is not enough fluid in the system to cool off the engine so the car overheats. Adding fluid solves t e problem. The signs and symptoms of Heat Exhaustion are: * Sweating Heat Exhaustion Treatment Victims of Heat Exhaustion must be properly re-hydrated and must be very careful about resuming physical activity (it is best to see a physician before doing so). Treatment is as described above for Heat Syncope, but the person should be more conservative about resuming physical activity to give the body a chance to recover. Have the person rest (lying down) in the shade. Replace fluid with a water/salt solution (commercial "rehydration" mix or ½ teaspoon salt and amp;frac12; teaspoon baking soda per quart/0.9 liter) (see Fluid Balance page 00). Drink slowly, drinking too much, too fast very often causes nausea and vomiting. Evacuation usually is not necessary. Heat Exhaustion can
become Heat Stroke if not properly treated (see Heat Stroke above). A victim of
Heat Exhaustion should have be closely monitored to make sure that their
temperature does not go above 103° F (39° C) If it does so, treat the
person for Heat Stroke as described above. * Skin is white and "wooden" feel all the way through * Freezing of top layers of skin tissue * Rewarm the area gently, generally by blowing warm air on it or placing the area against a warm body part (partner's stomach or armpit) * Do not rub the area - this can damage the effected tissue by having ice crystals tear the cell Rewarming of Frostbite * Rewarming is accomplished by immersion of the effected part into a water bath of 105 - 110 degrees F. No hotter or additional damage will result. This is the temperature which is warm to your skin. Monitor the temperature carefully with a thermometer. Remove constricting clothing. Place the appendage in the water and continue to monitor the water temperature. This temperature will drop so that additional warm water will need to be added to maintain the 105 - 110 degrees. Do not add this warm water directly to the injury. The water will need to be circulated fairly constantly to maintain even temperature. The effected appendage should be immersed for 25 - 40 minutes. Thawing is complete when the part is pliable and color and sensation has returned. Once the area is rewarmed, there can be significant pain. Discontinue the warm water bath when thawing is complete. * Do not use dry heat to rewarm. It cannot be
effectively maintained at 105 - 110 degrees and can cause burns further damaging
the tissues. Special Considerations for Frostbite * If the person is hypothermic and frostbitten, the
first concern is core rewarming. Do not rewarm the frostbitten areas until the
core temp approaches 96 degrees. All the body's fluids make up one large body fluid pool. Losses of fluid from any one source is reflected in the levels of all the body's other fluids: e.g. profuse sweating will ultimately result in decreased blood volume. If a patient loses enough fluid through any manner-bleeding, sweating, vomiting, or diarrhea-the end result is the same: dehydration and, potentially, volume shock. Adequate fluid is also critically important in hot environments to help our body thermoregulate If someone is chronically losing fluid (from diarrhea or vomiting), then you have a real emergency on your hands. Treat the cause of the fluid lose as best you can and rehydrate the patient. Be prepared to evacuate your patient. Dehydration is always easier to prevent than it is to treat. So it is important to ensure that all members of your group replace their regular fluid losses by drinking adequate amounts of water (see below). Your body absorbs fluids best when you drink frequently and in small amounts rather than drinking large amounts at one time. It also helps with fluid absorption if you drink while eating. A pinch of salt and sugar in the water will do if no food is available. Very dilute mixtures of sports drinks like Gatorade® (add just enough to taste) work well for this purpose. Don't depend on feeling thirsty to tell you when to drink. Thirst is a late response of the body to fluid depletion. Once you feel thirsty, you are already low on fluids. The best indicator of proper fluid levels is urine output and color. You, and all the people in your group should strive to be "copious and clear." Ample urine that is light colored to clear shows that the body has plenty of fluid. Dark urine means that the body is low on water, and is trying to conserve its supply by hoarding fluid which means that urine becomes more concentrated (thereby darker). Basic Fluid Recommendations Season/Weather Quarts/day Explanation Fall & Spring Backpacking* 2-3 quarts/1.8-2.8 liters This is what an average person will need on a daily basis in general temperate conditions. Hot Weather Backpacking* 3-4 quarts/2.8-3.7 liters In hot and humid weather you are losing additional fluid through sweating which must be replaced. Winter Backpacking* 3-4 quarts/2.8-3.7 liters In the winter time you are losing moisture through evaporation to the dry air and especially through respiration. Dry air entering the lungs heats up and is exhaled saturated with moisture. *All Seasons Add 1quart/1.8 liters At high altitude the body looses more fluid. Increase your fluid intake if you are traveling at high altitudes (over 8,000 feet/2,438 meters) Sunburn is overexposure of the skin to the ultraviolet rays of the sun. The biggest risk of exposure to these rays occurs between the hours of 10am and 2pm. Risk of a burn varies with length of time in the sun, complexion of the skin, proximity to the equator, and altitude. What are the symptoms? Symptoms include redness, warmth and blistering of the skin. Pain tends to be variable with each person, thus the amount of discomfort does not necessarily correlate with the severity of the burn. More significant burns will cause additional symptoms including a flu-like illness characterized by fever, chills, and headache. In addition, burns can make one more prone to dehydration. Treatment * Use a cool washcloth to apply compresses to the skin.
This allows for cooling relief When to get immediate attention * If the patient has signs of dehydration or heatstroke
including fainting, decreased urination, or unwillingness to take fluids 1. Have someone stay with the victim to be sure that
they do not have an allergic reaction. Allergic reactions to bee stings can be deadly. People with known allergies to insect stings should always carry an insect sting allergy kit and wear a medical ID bracelet or necklace stating their allergy. See a physician about getting either of these. There are several signs of an allergic reaction to bee stings. Look for swelling that moves to other parts of the body, especially the face or neck. Check for difficulty in breathing, wheezing, dizziness or a drop in blood pressure. Get the person immediate medical care if any of these signs are present. It is normal for the area that has been stung to hurt, have a hard swollen lump, get red and itch. Reducing the Risk of Being Stung 1. Wear light-colored, smooth-finished clothing. Tick Removal If you find a tick on your body, remove it AS SOON AS
POSSIBLE. A special Tick Removal Tool works best. Attach it to the tick and pull
gently while rotating counter-clockwise. If you don't have one, use tweezers.
Bent "needle nose" tweezers work best. Do NOT use nail polish, vaseline,
matches, or other methods (the latter procedures may traumatize the tick and
cause it to regurgitate its gut contents). Grasp the tick with tweezers around
its head, close to the skin. Pull it up and out slowly and firmly. Disinfect the
bite afterward with antiseptic. Tick Prevention 1. Avoiding ticks outdoors 2. Use a repellent * Apply to shoes, socks, and pants, and allow to
dry: 2. N,N-Diethyl-meta-toluamide, commonly known as DEET ("Off," "Cutter," "Muskol," etc.) --repels ticks; labeled for skin or clothing. CAUTION: Certain people are sensitive to formulations of DEET that contain more than 50% active ingredient. The Early Signs of Lyme Disease * Headache Lyme disease symptoms mimic many other diseases. About 70
percent of Lyme disease victims will develop a rash within two days to four
weeks. If untreated, more severe symptoms may develop--sometimes months to years
later. Transport the patient as quickly as possible to antivenin (antidote). Although local discomfort may be severe, systemic signs and symptoms maybe delayed for two to six hours following the bite. Walking your patient out is reasonably safe unless severe signs and symptoms occur. It is also significantly faster than trying a carry. Splint the affected part if possible. Expect swelling. Remove constricting items such as rings, bracelets, and clothing from the bitten extremity. Do not delay. Immediately following the bite of a snake thought to be poisonous, evacuation should be started. It can always be slowed down or canceled if it becomes obvious that envenomation did not occur, or the snake is not poisonous. Most medical experts agree that traditional field treatments such as tourniquets, pressure dressing, ice packs, and "cut and suck" snakebite kits are generally ineffective and are possibly dangerous. Poisonous snakebite is one of those conditions that you cannot treat in the field. Don't waste valuable time trying. Snakebite in the U.S. should be treated conservatively. There is no need to jump in with knives, tourniquets, ice, or compression bandages. There is no need to try to suck out the venom by mouth. Carrying out any of these extreme procedures has the potential to do far more harm than good. If it is going to be more than one hour to transport, you
should consider rinsing and disinfecting the wound. Treatment At the first sign of discomfort, remove boots and socks and place a piece of adhesive tape over the affected area. If it is absolutely necessary, open a blister by first washing the area thoroughly then inserting a sterilized needle into the side of the blister. Apply disinfectant and a bandage. Blister Prevention Double-check the boot fit. If you're a beginning backpacker and you're not used to the feel of hiking boots, wear them at home for a couple of days for several hours to be sure they are comfortable. Seek out a reputable store and an experienced salesperson to find the best fit. If you wear them at home and they don't feel right, you can take them back to the store for exchange. Break in your boots. This is usually as much of an issue of toughening your feet as softening your boots. Any way you look at it, your feet and boots are going to have to reach a compromise, and better they work out their differences near home than on the trail. I like to walk about 50 miles in new boots before I hit the trail (which is great exercise, too). But even trustworthy comfy boots need to be reintroduced to your feet if you've been sitting around all winter. Before a big trip, I'll go out for a couple of four- or five-mile shorties near home, just so my feet and my boots can renew their acquaintance. Wear wicking socks—polypropylene or nylon are fine—under a pair of wool or wool-and-nylon blend outer socks. The wicking socks are less abrasive, plus they move moisture away from your feet. Never wear cotton socks—cotton absorbs moisture and practically guarantees blisters. Go easy on the mileage and keep your packweight as low as possible. The absolutely number one most important rule of blister prevention: The second you feel the slightest hint of something rubbing in your shoe, STOP! Ignore your hiking partner's pleas to just keep going. Find the pebble, grass-seed, clump of dirt, grain of sand, or wrinkle in the sock. If it's a tight boot that's causing trouble, rub the inside of your boot with the blunt, rounded end of a Swiss army knife to try to stretch the leather or fabric. If you know you've got a vulnerable trouble spot, like the back of your heel, put a piece of moleskin on it before you start walking. Treat a hot spot with moleskin on the trail. If a blister
has already started forming (it can happen in mere seconds), use a dressing
called Second Skin (available from Spenco). This dressing was developed to treat
burns—and after all, blisters are nothing more than friction burns. Whether
you're putting moleskin over a hot spot or adhesive tape over a Second Skin
dressing, remember that tape adheres better to dry skin than wet skin—so use a
bandanna to dry your sweaty feet first.
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