Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Wilderness First Res
NOLS Wilderness First Responder v1.01
| Question | Answer |
|---|---|
| What are the components of the primary assessment in the correct order? | Scene size-up, initial patient assessment (Level of Responsiveness, ABCDEs), critical interventions, rapid body survey, vital signs, and history. |
| What does AVPU stand for in the context of assessing level of responsiveness? | Alert, Verbal, Pain, Unresponsive. |
| When assessing circulation in a patient, what are you specifically checking for? | Pulse quality and rate, skin color, temperature, and moisture, and capillary refill time. |
| What are the normal respiratory rates for an adult at rest? | 12-20 breaths per minute. |
| What are the "red flag" signs that might indicate increased intracranial pressure? | Decreasing level of consciousness, unequal pupils, abnormal motor or sensory function, projectile vomiting, and seizures. |
| What are the four core vital signs assessed in wilderness medicine? | Level of responsiveness (LOR), heart rate, respiratory rate, and skin condition. |
| What is a normal adult blood pressure range? | Systolic: 100-140 mmHg Diastolic: 60-90 mmHg. |
| What is the significance of a widening pulse pressure in a head injury patient? | It may indicate increasing intracranial pressure and is a late sign of brain herniation. |
| How often should vital signs be reassessed in a stable patient? | Every 15-30 minutes initially, then every 2-4 hours if stable. |
| What is the proper technique for assessing capillary refill? | Press on the nail bed or skin until it blanches, then release and count the seconds until normal color returns. Normal is less than 2 seconds. |
| What does the acronym SAMPLE stand for when taking a patient history? | Signs/Symptoms, Allergies, Medications, Past medical history, Last intake/output, Events leading to injury/illness. |
| What does OPQRST refer to when assessing pain? | Onset, Provokes/Palliates, Quality, Radiation, Severity, Time. |
| Why is it important to know a patient's last intake and output? | It provides information about hydration status, potential for shock, and metabolic conditions. |
| What medical conditions are particularly important to know about for wilderness activities? | Diabetes, seizure disorders, heart conditions, asthma, allergies, and psychiatric conditions. |
| What is a focused assessment? | A detailed examination of a specific body region where injury or illness is suspected, looking for DOTS (Deformities, Open wounds, Tenderness, Swelling). |
| What is the body's best mechanism for cooling itself? | Evaporation of sweat from the skin. |
| What are the signs and symptoms of heat exhaustion? | Headache, dizziness, nausea, vomiting, fatigue, heavy sweating, normal or elevated body temperature, and tachycardia. |
| What distinguishes heat stroke from heat exhaustion? | Heat stroke involves altered mental status and very high body temperature (>104°F/40°C). |
| What is the field treatment for heat stroke? | Rapid cooling by any means available (cold water immersion if possible), remove from heat source, and immediate evacuation. |
| What factors increase the risk of heat illness? | Dehydration, high humidity, lack of acclimatization, certain medications, alcohol consumption, and obesity. |
| What is the "umbles" mnemonic and what condition does it apply to? | Stumbles, Mumbles, Fumbles, Grumbles. It applies to hypothermia and represents deterioration in physical and mental capabilities. |
| What stages of hypothermia warrant thermal stabilization (hypowrap)? | Moderate and severe hypothermia. |
| Is it safe to allow someone who was found in moderate hypothermia to stand up and exercise to increase circulation? | False. This can cause "afterdrop," where cold blood from extremities returns to the core, further decreasing core temperature and potentially causing cardiac arrest. |
| Where should external warming devices be placed when treating hypothermia? | External warming devices should be placed on the high-heat areas of the body: axilla (armpits), neck, groin, and chest. |
| What are considered "safe" external warming devices for hypothermia? | Hot water bottles, chemical heat packs, and warm rocks (properly insulated to prevent burns). |
| What are the common signs and symptoms of Acute Mountain Sickness (AMS)? | Headache, nausea, dizziness, fatigue, loss of appetite, and sleep disturbances. |
| How do you treat AMS in the field? | Stop ascent, rest, hydrate, consider medication (acetazolamide if available), and descend if symptoms worsen. |
| What are the signs and symptoms of High Altitude Pulmonary Edema (HAPE)? | Persistent dry cough, shortness of breath at rest, weakness, decreased exercise performance, pink/frothy sputum, and respiratory crackles. |
| What is the treatment for HAPE? | Immediate descent (at least 2,000-3,000 feet), oxygen if available, and medications like nifedipine if available and trained in its use. |
| What is the anticipated worst-case scenario for High Altitude Cerebral Edema (HACE)? | Death due to brain herniation if descent is not initiated promptly. |
| What is the differentiating factor between mild and severe dehydration? | Mild dehydration has minimal symptoms with normal vital signs, while severe dehydration involves altered mental status, severe fatigue, sunken eyes, dry mucous membranes, and abnormal vital signs (tachycardia, hypotension). |
| How can you try to reverse moderate-to-severe dehydration in the field? | Oral rehydration with electrolyte solutions, having the patient drink small amounts frequently, and monitoring for improvement or deterioration. |
| What is the differentiating factor between mild and severe hyponatremia? | Mild hyponatremia presents with nausea, headache, and fatigue, while severe hyponatremia involves altered mental status, seizures, and coma. |
| What is the treatment for mild hyponatremia? | Stop fluid intake temporarily, consume salty foods or electrolyte solutions, and monitor for symptom improvement. |
| What is the treatment for severe hyponatremia? | Immediate evacuation, 3-5% hypertonic saline if available and trained in its use, and management of seizures if they occur. |
| What are the key steps in cleaning a wilderness wound? | Irrigate with clean water (ideally with pressure), remove foreign debris, evaluate for underlying damage, and dress appropriately. |
| How much pressure is recommended for wound irrigation? | 8-12 psi, which can be achieved using a syringe or improvised pressure irrigation device. |
| What are signs of wound infection? | Increasing pain, redness, swelling, warmth, pus, red streaks extending from wound, fever, and lymph node enlargement. |
| What types of wounds should not be closed in a wilderness setting? | Animal bites, puncture wounds, wounds over 24 hours old, obviously infected wounds, and heavily contaminated wounds. |
| When should a patient with a wound be evacuated? | When the wound: requires advanced care beyond your abilities, shows signs of infection, involves damage to underlying structures, has high contamination risk, or is on the face or over joints. |
| What are the signs and symptoms of a dislocated joint? | Deformity, severe pain, inability to move joint normally, and swelling. |
| What muscles need to be relaxed to reduce a shoulder dislocation? | The muscles around the shoulder girdle, especially the biceps, deltoid, and rotator cuff muscles. |
| What are the steps for realigning a fractured lower leg in the wilderness? | Explain procedure to patient, provide pain management if available, apply gentle traction in the direction of the limb until aligned, splint in the corrected position. |
| What are the indications for realigning an angulated fracture in the wilderness? | Compromised circulation, lack of distal pulses, deformities that cannot be splinted effectively, and extremities that cannot be evacuated in their current position. |
| What is a general rule for splinting fractures? | Splint the joint above and below the fracture site to immobilize the entire limb. |
| What are the red flags that might indicate a significant head injury? | Loss of consciousness, amnesia, persistent vomiting, worsening headache, unequal pupils, seizures, and abnormal mental status. |
| What is the current wilderness medicine approach to spinal immobilization? | Selective spinal immobilization based on mechanism of injury, patient reliability, and physical exam findings rather than automatic full immobilization. |
| What criteria must be met to clear the spine using the Focused Spine Assessment? | Patient must be reliable (normal mental status, no intoxication), have no distracting injuries, no spinal pain or tenderness on examination, and normal motor/sensory function. |
| What position should an unconscious patient without suspected spinal injury be placed in? | The recovery position (on their side) to maintain an open airway and prevent aspiration. |
| How would you evacuate a patient with a suspected spinal injury in the wilderness? | Using the best available resources to maintain spinal alignment during transport, which might include improvised or commercial litters with padding and stabilization. |
| What are the signs and symptoms of a pneumothorax? | Shortness of breath, chest pain, diminished breath sounds on the affected side, and possibly tachypnea and tachycardia. |
| How do you treat a sucking chest wound in the field? | Apply an occlusive dressing sealed on three sides to create a one-way valve effect, monitor for worsening respiratory distress. |
| What is a flail chest and why is it serious? | A segment of chest wall with multiple rib fractures that moves paradoxically with respiration. It's serious because it impairs ventilation and is associated with underlying lung contusion. |
| What are the signs of a cardiac tamponade? | Beck's triad: muffled heart sounds, distended neck veins, and low blood pressure, along with narrow pulse pressure and pulsus paradoxus. |
| What is the significance of coughing up bright red frothy blood? | It suggests pulmonary contusion or edema, which can lead to respiratory compromise and requires rapid evacuation. |
| What are the steps for adult CPR? | Ensure scene safety, check responsiveness, call for help, start chest compressions (30), open airway, give 2 breaths, continue 30:2 ratio. |
| What are the signs and symptoms of a severe asthma attack? | Severe shortness of breath, inability to speak in full sentences, use of accessory muscles, drowsiness, confusion, and possibly cyanosis. |
| What is the first-line treatment for anaphylaxis in the wilderness? | Administration of epinephrine via auto-injector if available, then antihistamines and other supportive measures. |
| What are the signs and symptoms of angina versus heart attack? | Angina typically resolves with rest and/or nitroglycerin, while heart attack pain persists, may be accompanied by nausea, vomiting, and shortness of breath, and often radiates to the jaw, arm, or back. |
| What should you monitor in someone who swam a rapid and may have inhaled water? | Respiratory status including rate, effort, and oxygen saturation if available, as they may develop delayed pulmonary edema. |
| What symptoms suggest appendicitis? | Initially periumbilical pain moving to the right lower quadrant, loss of appetite, nausea, vomiting, fever, and guarding. |
| What are the signs and symptoms of an ectopic pregnancy? | Lower abdominal pain (often one-sided), vaginal bleeding, missed period, and possibly shoulder pain if rupture has occurred. |
| How would you assess for peritonitis in the field? | Check for abdominal rigidity, rebound tenderness, guarding, and pain with movement or coughing. |
| What are the signs of a GI bleed? | Hematemesis (vomiting blood), melena (black, tarry stools), weakness, dizziness, and signs of shock if severe. |
| What is the initial management for a suspected kidney stone in the wilderness? | Pain management, hydration, and urine straining if possible to catch the stone for later analysis. |
| What are the signs of increased intracranial pressure? | Declining mental status, headache, vomiting, unequal pupils, abnormal posturing, Cushing's triad (bradycardia, hypertension, irregular breathing). |
| What is the FAST assessment for stroke? | Face drooping, Arm weakness, Speech difficulties, Time to call for help. |
| How do you manage a seizure in the wilderness? | Protect from injury, time the seizure, place in recovery position after seizure ends, monitor vital signs, and assess for causes. |
| What is the difference between a focal and generalized seizure? | Focal seizures affect one part of the brain and may cause localized symptoms, while generalized seizures involve the entire brain and typically cause loss of consciousness. |
| How do you differentiate between a syncopal episode and a seizure? | Syncopal episodes typically have a prodrome (lightheadedness, nausea), brief loss of consciousness, and quick recovery without postictal confusion or incontinence, unlike many seizures. |
| What are the symptoms of Giardia infection? | Diarrhea, abdominal cramps, bloating, nausea, fatigue, and sometimes weight loss. |
| How is Norovirus transmitted, and what are its symptoms? | It's transmitted through fecal-oral route, contaminated food/water, or contact with infected surfaces. Symptoms include sudden onset of vomiting, watery diarrhea, abdominal cramps, and sometimes fever. |
| What wilderness hygiene practices help prevent gastrointestinal infections? | Proper hand washing, water disinfection, appropriate food storage, proper human waste disposal, and clean cooking practices. |
| What are the signs and symptoms of a urinary tract infection? | Burning with urination, frequency, urgency, cloudy or bloody urine, lower abdominal pain, and sometimes fever if the infection has spread. |
| How can you differentiate between a kidney infection and a lower urinary tract infection? | Kidney infections typically include fever, flank pain, nausea/vomiting, and generally feeling more ill than with a lower UTI. |
| What are the essential categories for a wilderness medical kit? | Personal protection, wound care, medications, tools, splinting/bandaging materials, and documentation supplies. |
| What factors should be considered when assembling a wilderness medical kit? | Trip duration, group size, activity type, remoteness, environmental conditions, and medical training of group members. |
| What items are essential for wound cleaning in a wilderness medical kit? | Irrigation syringe, clean water, antiseptic solution, and cleaning instruments like tweezers and gauze. |
| What are appropriate splinting materials for a wilderness medical kit? | SAM splints, padded aluminum splints, trekking poles, sleeping pads, or other rigid materials that can be improvised. |
| What documentation should be included in a wilderness medical kit? | Waterproof paper, pencil, SOAP note templates, emergency contact information, and evacuation guidelines. |
| What information must be gathered before administering any medication in the wilderness? | Allergies, current medications, medical conditions, previous experiences with the medication, and last oral intake. |
| What are the five rights of medication administration? | Right patient, right drug, right dose, right route, right time. |
| What is the proper technique for administering an epinephrine auto-injector? | Remove safety cap, place firmly against outer thigh, hold for 3-10 seconds (depending on device), massage injection site afterward. |
| What common wilderness medications might interact with MAO inhibitors? | Pseudoephedrine, other decongestants, and certain pain medications. |
| How should medications be stored in wilderness conditions? | Protected from extreme temperatures, moisture, and direct sunlight, typically in waterproof containers. |
| How do normal vital signs differ in children compared to adults? | Children have faster heart and respiratory rates, which decrease with age toward adult values. |
| What are special considerations when treating pediatric patients in the wilderness? | Faster heat loss, greater risk of dehydration, different medication dosing, and need for age-appropriate communication. |
| How should you modify CPR for an infant in the wilderness? | Use two fingers for compressions, compress to 1/3 depth of chest, maintain a ratio of 30:2 for single rescuer or 15:2 for two rescuers. |
| What signs of dehydration are particularly important to monitor in children? | Decreased tears, dry mucous membranes, decreased urine output, sunken fontanelle (in infants), and altered mental status. |
| How does the assessment of a pediatric patient differ from an adult? | Build rapport first, involve caregivers, observe before touching, and be aware that verbal reports of symptoms may be less reliable. |
| What physiological changes in elderly patients affect their response to environmental emergencies? | Decreased thermoregulation, reduced thirst sensation, decreased muscle mass, and often multiple pre-existing medical conditions. |
| How might heart attack symptoms present differently in elderly patients? | Atypical presentations are common, including fatigue, shortness of breath, confusion, or syncope without chest pain. |
| What special considerations exist for treating elderly patients with hypothermia? | Higher risk due to decreased thermoregulation, careful rewarming to avoid cardiac strain, and close monitoring for complications. |
| What medication concerns are more common in elderly wilderness participants? | Polypharmacy, increased risk of side effects, altered drug metabolism, and potential for drug-drug interactions. |
| How might fractures present differently in elderly patients? | May occur with minimal trauma, might present with less pain due to decreased sensation, and may have delayed or poor healing. |
| What are the signs that someone might be experiencing an acute stress reaction? | Emotional responses (fear, anxiety), physical symptoms (rapid heart rate, nausea), cognitive effects (confusion, difficulty concentrating), and behavioral changes. |
| How should you approach someone having a panic attack in the wilderness? | Speak calmly, move to a quiet area if possible, encourage slow breathing, use grounding techniques, and reassure that symptoms will pass. |
| What are the risks if a participant stops taking anti-depressant medication in the field? | Potential for withdrawal symptoms, return of depression symptoms, anxiety, irritability, sleep disturbances, and in some cases, suicidal ideation. |
| What are signs that a psychiatric emergency may require evacuation? | Threat to self or others, inability to care for basic needs, extreme agitation not responding to de-escalation, or psychosis. |
| How should you approach a patient with a suspected behavioral health emergency? | Ensure scene safety, approach calmly, maintain personal space, speak clearly and simply, avoid confrontation, and consider involving someone the person trusts. |
| What are the differences in respect to the signs and symptoms between neurotoxic and hemolytic venoms? | Neurotoxic venoms typically cause neurological symptoms (muscle weakness, respiratory difficulty, paralysis), while hemolytic venoms cause tissue destruction, bleeding, and potentially systemic coagulopathy. |
| What is the field treatment for a black widow spider bite? | Clean the bite site, apply cold to reduce pain, monitor for severe symptoms, use pain medication if available, and evacuate if symptoms are severe or the victim is a child or elderly. |
| What are the signs and symptoms of a rattlesnake bite? | Progressive swelling, pain, bruising, and in severe cases, coagulopathy, hypotension, and neurological symptoms. |
| What should NOT be done when treating a venomous snakebite in the wilderness? | Do not use tourniquets, cut the wound, attempt to suck out venom, apply ice directly to the bite, or give the patient alcohol or sedatives. |
| What are the signs of a severe reaction to a scorpion sting? | Pain, paresthesias, muscle twitching, roving eye movements, excess salivation, difficulty swallowing, and in severe cases, respiratory distress. |
| What are the symptoms of poison ivy, oak, or sumac exposure? | Itching, redness, swelling, blisters in a linear pattern where plant contacted skin, developing hours to days after exposure. |
| How should you treat a wilderness patient who has ingested unknown berries and is showing signs of toxicity? | Maintain ABCs, do not induce vomiting, document what was ingested if possible, monitor vital signs, and evacuate. |
| What are the symptoms of water hemlock poisoning? | Gastrointestinal distress, excessive salivation, dilated pupils, and progression to seizures and potentially death. |
| What plants commonly cause cardiac glycoside poisoning in the wilderness? | Foxglove, oleander, lily of the valley, and certain milkweed species. |
| What are the signs and symptoms of death cap mushroom ingestion? | Initial gastrointestinal symptoms followed by apparent recovery, then liver failure developing 3-5 days after ingestion. |
| What are the symptoms of carbon monoxide poisoning? | Headache, dizziness, nausea, confusion, cherry-red lips and skin in severe cases, and potentially loss of consciousness. |
| What are the dangers of cooking in a poorly ventilated tent? | Carbon monoxide poisoning, which can cause headache, confusion, loss of consciousness, and potentially death. |
| What are the dangers of many people sleeping in a poorly ventilated snow cave? | Oxygen depletion and carbon dioxide buildup leading to headache, confusion, and potentially asphyxiation. |
| What are the signs and symptoms of hydrogen sulfide exposure in the wilderness? | Smell of rotten eggs (though smell may be lost at higher concentrations), eye irritation, respiratory irritation, and neurotoxic effects at higher concentrations. |
| What is the treatment for smoke inhalation in the wilderness? | Remove from smoke source, provide clean air/oxygen if available, monitor respiratory status, and evacuate if respiratory distress develops. |
| What is the anticipated worst-case scenario for a T4 spinal fracture? | Permanent paralysis below the level of injury if the spinal cord is damaged. |
| What is the anticipated worst-case scenario for a pelvic fracture? | Massive internal bleeding leading to shock and death. |
| What is the anticipated worst-case scenario for severe dehydration? | Hypovolemic shock, organ failure, and death. |
| What is the anticipated worst-case scenario for a wound not responding to treatment? | Infection spreading systemically leading to sepsis and death. |
| What is the anticipated worst-case scenario for heat stroke? | Multi-organ failure and death if cooling is delayed. |
| What factors determine whether to evacuate under your own power versus calling for outside assistance? | Patient condition, available resources, distance to definitive care, terrain, weather conditions, time of day, and the group's capabilities. |
| What information should be gathered before calling for a helicopter evacuation? | Patient condition, precise location (coordinates), elevation, weather conditions at scene, potential landing zones, and hazards. |
| How should a helicopter landing zone be prepared? | 100x100 foot area cleared of debris and obstacles, marked with bright objects in corners, dust suppressed if possible, and approaching the helicopter only when directed by crew. |
| When is a litter evacuation appropriate, and what are key considerations? | Appropriate for patients who cannot walk but don't require immediate advanced care. Consider team size (minimum 6 people), terrain, distance, weather, and having a plan for rest and rotation. |
| What techniques can be used for moving a patient over uneven terrain? | Hand carrying litter, litter carry with shoulder straps, litter wheel attachments, rope systems for steep terrain, and improvised methods like poles through backpack straps. |
| What does SOAP stand for in wilderness medicine documentation? | Subjective, Objective, Assessment, Plan. |
| What critical information must be included when transmitting patient information for evacuation? | Patient demographics, mechanism of injury/nature of illness, vital signs, key findings, interventions performed, and response to treatment. |
| How should patient confidentiality be managed in wilderness settings? | Share information only with those directly involved in care, avoid public radio transmissions of sensitive details, and protect written documentation. |
| What information should be included in a hand-off report when transferring care? | Complete patient history, assessment findings, interventions performed, response to interventions, trends in vital signs, and outstanding concerns. |
| How can communication be effectively maintained during an extended evacuation? | Establish regular check-in times, agree on communication protocols, have backup communication methods, and prioritize critical information. |
| How can a trekking pole be used to improvise a splint? | Pad the pole, place alongside the injured limb, and secure with bandanas, clothing, or tape, ensuring joints above and below fracture are immobilized. |
| How can you improvise a cervical collar in the wilderness? | Use a rolled jacket, sleeping pad sections, or a SAM splint formed into a collar shape and secured in place. |
| How can you improvise a pelvic wrap? | Use a sleeping pad, backpack, or clothing tied tightly around the pelvis at the level of the greater trochanters. |
| What are some improvised methods for creating wound irrigation pressure? | Clean water bag with a small hole poked in it, syringe created from plastic bottle, or using hydration bladder tube systems. |
| How can you improvise a chest seal for a sucking chest wound? | Use plastic packaging, credit card, or other non-porous material secured on three sides with tape to create a one-way valve effect. |
| What is a usable knee brace and how is it constructed? | A functional knee support created using athletic tape in a specific pattern to provide stability while allowing controlled movement. |
| How is a usable ankle tape applied? | Creating a supportive structure with athletic tape that stabilizes the ankle while allowing for controlled movement during evacuation. |
| What are the steps for performing a focused spine assessment? | Check mechanism of injury, assess reliability, check spine for tenderness, test motor and sensory function in all extremities. |
| How is a pelvic wrap properly applied? | The wrap is centered at the level of the greater trochanters (hip bones) and tightened to reduce pelvic volume and stabilize fractures. |
| What is the proper technique for reducing a shoulder dislocation using the Hennepin technique? | Patient lies prone with dislocated arm hanging off edge, attach weight (5-10 lbs) to wrist, wait for muscle relaxation and reduction. |
| What is the START triage system and how is it applied? | Simple Triage And Rapid Treatment - patients are sorted into four categories (minimal, delayed, immediate, deceased) based on mobility, respiratory status, perfusion, and mental status. |
| How should resources be allocated when there are multiple patients in a wilderness setting? | Triage principles apply - treat the most critical patients who can be saved with available resources while considering the overall group safety. |
| What additional challenges does a multi-casualty incident present in the wilderness? | Limited resources, communication difficulties, extended care times, weather/environmental factors, and potential ongoing hazards. |
| How should a solo rescuer approach a multi-casualty scenario? | Ensure scene safety, conduct rapid initial triage, treat life threats, seek additional help, and consider group evacuation options. |
| What is the principle of "doing the greatest good for the greatest number" in wilderness rescue? | Resource allocation focuses on saving the most lives possible, which may mean not providing maximum care to every individual. |
| What must you monitor in folks who swam a rapid and may have inhaled water? | Respiratory status for signs of delayed pulmonary edema, which can develop hours after the incident. |
| What are the signs of drowning that may not be obvious to casual observers? | Quiet struggling (not waving/shouting), head tilted back, mouth at water level, glassy stare, and vertical body position with minimal movement. |
| What is the proper approach for a water rescue? | Reach, throw, row, go - attempt rescue in this order of increasing personal risk. |
| How does cold water immersion affect survival time? | Cold water accelerates heat loss (25 times faster than air), leading to rapid hypothermia. Survival times decrease dramatically as water temperature drops. |
| What is dry drowning and how is it managed? | Laryngospasm causing asphyxia without water in lungs, triggered by water hitting the larynx. Managed by monitoring respiratory status and providing ventilatory support if needed. |
| What safety considerations are essential when performing a slope or vertical evacuation? | Proper anchoring, redundant systems, edge protection, trained personnel, appropriate equipment, and clear communication. |
| What information should be communicated to incoming technical rescue teams? | Patient condition, exact location with coordinates, terrain features, available equipment, number of people requiring rescue, and weather conditions. |
| What are the medical considerations unique to patients requiring technical rescue? | Pressure injuries from harnesses, extended time in one position, environmental exposure, and potential for traumatic injuries during rescue. |
| How can patient packaging be optimized for technical terrain evacuations? | Secure immobilization, protection from environmental exposure, positioning to manage airway and prevent aspiration, and attachment points for rescue systems. |
| What is the role of the wilderness first responder during a technical rescue operation? | Patient care, monitoring vital signs, communicating medical concerns to technical team, anticipating medical needs, and preparing for transfer of care. |
| Under what circumstances might a wilderness first responder exceed their normal scope of practice? | When evacuation to definitive care is significantly delayed, communication with medical control is established, and the benefits outweigh the risks. |
| What is the concept of delayed or prolonged transport, and how does it affect wilderness care? | When evacuation times exceed urban expectations (>1 hour), care protocols must be adapted for extended monitoring and intervention. |
| How does the assessment and management of wounds change in extended care situations? | More aggressive cleaning, consideration of closure techniques, daily wound checks, and vigilance for infection become more important. |
| What additional monitoring parameters become important in extended care scenarios? | Fluid intake/output, nutrition, sleep, mental status trends, wound changes, and ongoing pain levels. |
| How do wound closure decisions differ between wilderness and urban settings? | In wilderness, the decision balances infection risk against functional benefits and cosmetic outcomes, considering evacuation time and wound characteristics. |
| What considerations should guide medication administration in extended care? | Initial dose effectiveness, duration of action, available quantity, side effects, contraindications, and patient-specific factors. |
| What is the role of antibiotics in wilderness medicine? | Prophylaxis for high-risk wounds, treatment of established infections, and management of specific wilderness-related infections when evacuation is delayed. |
| How should pain be managed in extended wilderness care? | Using a multimodal approach including positioning, splinting, cold/heat therapy, and appropriate medications if available. |
| What information should be documented when administering medications in the wilderness? | Drug name, dose, route, time, indication, effect, and any adverse reactions. |
| What considerations guide the use of epinephrine for anaphylaxis in the wilderness? | Severity of symptoms, previous responses to epinephrine, available doses, distance from definitive care, and ability to manage side effects. |
| What medical screening should be conducted before wilderness expeditions? | Review of medical history, medications, allergies, fitness level, psychological readiness, and specific concerns related to the environment. |
| How should chronic medications be managed on extended expeditions? | Bring adequate supply plus extra, appropriate storage conditions, documentation, and contingency plans for lost or damaged medications. |
| What special considerations exist for diabetic patients on wilderness expeditions? | Effects of exercise on blood glucose, medication storage, monitoring supplies, meal planning, and emergency glucose sources. |
| How should medical kits be modified for international expeditions? | Consider endemic diseases, language barriers, medication availability, legal considerations for carrying certain medications, and cultural aspects of care. |
| What strategies help prevent common expedition medical problems? | Proper acclimatization, hydration protocols, foot care regimens, sun protection, hygiene practices, and fitness preparation. |
| What is the concept of "duty to act" and how does it apply to wilderness first responders? | Legal obligation to provide care, which varies by jurisdiction but generally applies when there is a pre-existing relationship (guide/client) or when care has been initiated. |
| What is informed consent, and how is it obtained in wilderness medicine? | Permission granted by a patient after understanding the nature, risks, and benefits of treatment. In wilderness, it may be verbal but should be documented when possible. |
| What documentation is essential from a legal perspective in wilderness medicine? | Patient assessment, interventions performed, patient response, decision-making rationale, and consent discussions. |
| What legal protections may apply to wilderness first responders? | Good Samaritan laws (vary by location), organizational liability coverage, and scope of practice guidelines from certifying organizations. |
| What constitutes abandonment in wilderness medicine? | Terminating care without ensuring the patient has access to equal or better care, or leaving a patient who requires ongoing care. |
| What ethical principles guide decision-making in wilderness medicine? | Beneficence (do good), non-maleficence (do no harm), autonomy (patient choice), justice (fair resource allocation), and fidelity (keeping promises). |
| How should confidentiality be balanced against group safety in wilderness settings? | Share only information necessary for safety while respecting privacy obtain consent for sharing when possible. |
| What ethical considerations arise when deciding to call for helicopter evacuation? | Risk to flight crew, resource allocation, cost, environmental impact, and necessity balanced against patient benefit. |
| How should scarce medical resources be allocated in remote settings? | Based on medical need, likelihood of benefit, conservation for future needs, and consultation with team members when possible. |
| What ethical challenges are presented when a patient refuses recommended evacuation? | Respecting autonomy while ensuring the patient fully understands risks, documenting the discussion, and considering impacts on the group. |
| A climber falls 20 feet and presents with pain in the right thigh, deformity, and inability to bear weight. What injury should you suspect and how would you manage it? | Suspect femur fracture. Manage by checking distal circulation, sensation, and motion providing pain management applying traction splint or improvised splint and evacuating due to the high risk of blood loss and shock. |
| A hiker was struck by a falling rock and has an open wound on the head with blood in the ear canal. What condition should you suspect and how would you manage it? | Suspect a basal skull fracture. Manage by stabilizing cervical spine, controlling external bleeding without applying pressure to depressed skull areas, protecting airway, monitoring for increasing ICP, and arranging urgent evacuation. |
| A skier collides with a tree and presents with difficulty breathing, paradoxical chest movement, and decreasing oxygen saturation. What injury is likely and how would you manage it? | Likely a flail chest with potential underlying pulmonary contusion. Manage by stabilizing the flail segment, providing oxygen if available, assisting ventilations if necessary, and arranging urgent evacuation. |
| A kayaker is hit in the abdomen by their boat after a flip and presents with increasing abdominal pain, rigidity, and signs of shock. What condition should you suspect and how would you manage it? | Suspect internal bleeding from abdominal trauma. Manage by positioning supine with knees slightly flexed, monitoring vital signs, providing nothing by mouth, treating for shock, and arranging urgent evacuation. |
| A backcountry skier presents with shoulder deformity, pain, and inability to move the arm after a fall. What injury is likely and what factors would you consider before attempting reduction? | Likely shoulder dislocation. Consider: patient consent, your training level, time to evacuation, patient comfort level, availability of pain management, and potential for neurovascular compromise before attempting reduction. |
| A backpacker develops nausea, headache, dizziness, and difficulty concentrating at 11,000 feet after rapid ascent. What condition is this and how would you manage it? | Acute Mountain Sickness (AMS). Manage by stopping further ascent, rest, hydration, pain medication for headache, consider acetazolamide if available, and descend if symptoms worsen. |
| During a desert hike, a group member becomes confused, stops sweating, and has hot, dry skin with a temperature you estimate above 103°F. What condition is this and how would you manage it? | Heat stroke. Manage by moving to shade, aggressively cooling (cold water immersion ideal), removing excess clothing, hydrating if conscious, monitoring vital signs, and arranging urgent evacuation. |
| A participant on a winter expedition is found mumbling incoherently, stumbling, and has stopped shivering despite cold exposure. What condition is this and how would you manage it? | Moderate to severe hypothermia. Manage by handling gently, insulating from cold (including ground), adding heat to core areas, avoiding standing or exercise, maintaining horizontal position, and arranging evacuation. |
| A whitewater rafter who swallowed water after flipping develops a cough and increasing shortness of breath several hours later. What condition should you suspect and how would you manage it? | Suspect delayed pulmonary edema from aspiration. Manage by positioning upright to ease breathing, administering oxygen if available, monitoring respiratory status, and arranging evacuation. |
| A diabetic expedition member becomes confused, shaky, and sweaty. What condition is likely and how would you manage it? | Likely hypoglycemia. Manage by administering oral glucose if conscious (juice, honey, glucose tablets), monitoring response, following with complex carbohydrates if improvement occurs, and arranging evacuation if no improvement. |
| A hiker presents with painful, red, swollen limb after a snake bite with two puncture marks. What assessment findings would indicate a venomous bite requiring evacuation? | Progressive swelling, ecchymosis (bruising), severe pain, systemic symptoms (nausea, vomiting, dizziness), abnormal vital signs, or neurological changes would indicate a venomous bite requiring evacuation. |
| While camping at high altitude, a participant wakes with severe shortness of breath, frothy pink sputum, and crackling sounds when breathing. What condition is this and how would you manage it? | High Altitude Pulmonary Edema (HAPE). Manage by immediate descent (at least 2,000-3,000 feet), oxygen if available, keeping warm, minimizing exertion, considering nifedipine if available and trained in its use, and arranging evacuation. |
| A participant taking lithium for bipolar disorder becomes confused, develops tremors, and has difficulty walking. What condition might you suspect and how would you manage it? | Suspect lithium toxicity. Manage by stopping lithium intake, ensuring hydration, monitoring vital signs and neurological status, and arranging evacuation for medical evaluation. |
| During a lightning storm, a hiker is found unresponsive after a nearby strike with no pulse or breathing. What special considerations exist for this scenario? | |
| A group member develops severe diarrhea, vomiting, and abdominal cramps affecting the entire camp 24 hours after arrival. What is the likely cause and how would you manage the situation? | |
| You're leading a group 2 days from the trailhead when a member develops moderate altitude illness that isn't improving with rest. What evacuation decision would you make and why? | Descend with the entire group or a team with the patient since altitude illness can rapidly progress to life-threatening conditions (HAPE/HACE), and symptoms only resolve with descent. |
| A patient with an open femur fracture is 6 hours from definitive care by helicopter but bad weather is moving in. What considerations would guide your evacuation decision? | |
| Your patient has a simple ankle sprain but can't bear weight, and you're 8 miles from the trailhead. What evacuation options would you consider? | Consider: patient assistance with improvised crutches/trekking poles, carrying minimal gear, short evacuation with group assistance, splitting group if adequate leadership exists, improvised carries for difficult sections, or calling for non-emergency ass |
| A participant discloses they've stopped taking anti-depressant medication and now feels increasingly anxious and agitated. How would you approach this situation? | Assess for withdrawal symptoms and suicidal ideation, discuss medication resumption if available, implement supportive measures (rest, hydration, reduced stress), consider evacuation based on symptom severity, and maintain close observation. |
| Your group is at a remote high camp when a member develops severe HAPE symptoms at night with deteriorating condition. What decision-making process would you use to manage this situation? | Immediate action required: begin descent even at night if safely possible, use supplemental oxygen if available, minimize patient exertion, consider medication if available, contact rescue services if possible, and continue descent at first light if night |
Created by:
dscintille
Popular Paramedic/EMT sets