Chapter 2-1Basic Survival Medicine

Part 2 of 2

Unit 2Personal Protection

5. Bone and Joint Injury

Fractures Open (Compound)

Bone protrudes through the skin Complicates fracture with an open wound

Closed No open wounds Follow guidelines for immobilization Set and splint the fracture

Signs and symptoms of a fracture Pain Tenderness Discoloration Swelling deformity Loss of function Grating

5. Bone and Joint Injury

Sprains Accidental over stretching of a tendon or ligament causes sprains Signs and symptoms:

Pain Swelling Tenderness Discoloration (black and blue)

When treating sprains, think RICE: R - Rest injured area I - Ice for 24 hours, then heat after that C - Compression E - Elevation of the affected area

6. Wounds Wound = > Any physical injury causing a break in the skin

Examples: open wounds, skin diseases, frostbite, trench foot, burns

Any delay in treatment could cause infection, a serious threat Do not touch a wound with dirty hands or objects

One exception is when it's necessary to control arterial bleeding Promptly clean all wounds

Antibiotics, when available, should be taken for the control of infection. Treating open wounds:

Dressing and Bandages Cover wound with clean dressing after cleansing

A proper bandage will anchor the dressing to the wound and afford further protection

Bandages should be snug to prevent slippage, but not too tight

Lacerations (cuts) are best left open due to the probability of infection from the source that caused the laceration

Clean thoroughly, remove foreign material, apply dressing

6. Wounds Skin Diseases and Ailments

Boils Apply warm compresses to bring the boil to a head

Open the boil using a sterile knife, wire, needle, or similar item

Fungal Infections Keep skin clean and dry

Expose the infected area to as much sunlight as possible

Do not scratch the affected area

Rashes First determine what is causing the rash

Rules to follow:

If it is moist, keep it dry

If it is dry, keep it moist

Do not scratch it

Treat rashes as open wounds => clean and dress them daily

6. Wounds Frostbite => Results from frozen tissues

Light frostbite involves only the skin that takes on a dull, whitish look Deep frostbite extends to a depth below the skin Feet, hands, and exposed facial areas are vulnerable to frostbite Treating Frostbite:

Never thaw injured tissue if there is a possibility of freezing!!

Remove victim of frostbite from the cold environment

Treat the body as a whole—if hypothermic, warming the victim’s core is priority

Carefully remove clothing or jewelry in contact with the injured part of the body

Never rub the affected body part—ice crystals may still be present in deeper tissue

Do not allow victim to walk on injured feet or place body parts on hard surfaces

Cover with clean, dry dressing

Do not break any blisters

• Rewarming Procedures Do not thaw the affected areas using an open flame

If possible, warm affected area as quickly as possible in warm-water bath that is no hotter than 104 degrees F

Rewaming can be extremely painful—use analgesics like aspirin and motrin if available

less than Dry affected area and place it next to your skin to warm it at body temperature

6. Wounds Frostbite (continued)

• Rewarming Procedures Do not thaw the affected areas using an open flame

If possible, warm affected area as quickly as possible in warm-water bath that is no hotter than 104 degrees F

Rewarming can be extremely painful—use analgesics like aspirin or NSAIDS (motrin) if available

Keep warming until tissue is soft and color and sensation return

Dress the area with clean dressing

Protect from refreezing

Wrap fingers or toes so they are not in contact with each other

Elevate affected area and transport for medical attention

ALL VICTIMS WITH FROZEN TISSUE REQUIRE HOSPITALIZATION

6. Wounds Trench Foot

Results from many hours or days of exposure to wet or damp conditions at a temperature just above freezing

Nerves and muscles sustain the main damage, but gangrene can occur In extreme cases, flesh dies and may result in amputating the foot or leg Best prevention is to keep your feet dry.

Burns Cause severe pain Increase probability of shock and infection Can lead to loss of considerable body fluids and salts Treatment:

Covering burn with clean dressing of any type reduces pain and chance for infection

Maintenance of body fluids and salts is necessary

Only way to administer fluids in burn situations is by mouth

7. Bites and Stings General Treatment

If bitten on hands or feet, be sure to remove jewelry in case of swelling Keep the bite site lower than the heart if possible Apply cold packs to insect bites or stings Apply heat to marine stings (e.g., jellyfish) Vinegar can neutralize the venom or most marine organisms For snake bites, DO NOT APPLY heat or cold For all bites and stings, keep the victim calm and limit physical activity Transport to hospital as soon as possible

7. Bites and Stings Insect Bites

Mostly just an irritant Can cause severe allergic reactions in some individuals Can be carriers of diseases

In other countries, you may be exposed to serious, even fatal, diseases not encountered in the United States

Ticks => Rocky Mountain spotted fever, Lyme disease

Mosquitoes => Malaria, dengue, and many other diseases

Flies => Can spread disease from contact with infectious sources

Sleeping sickness, typhoid, cholera, and dysentery

Fleas => Plaque

Lice => Typhus, Relapsing fever

7. Bites and Stings

Insect Bites If bitten on hands or feet, be sure to remove jewelry in case of swelling Keep the bite site lower than the heart if possible Apply cold packs to insect bites or stings Immunizations can prevent most diseases from mosquitoes and flies If antibiotics are available, obtain and use them

Common fly-borne diseases usually treatable with penicillin or erythromycin

Most tick-, flea-, louse-, and mite-borne diseases are treatable with tetracycline

Most antibiotics come in 250 milligram (mg) or 500 mg tablets

2 tabs, 4 times a day, for 10 to 14 days will usually do the job

Bee and Wasp Stings If stung by a bee, immediately remove the stinger and venom sac, if attached, by

scraping with a fingernail or a knife blade. Wash sting site thoroughly with soap and water to lessen chance of infection

7. Bites and Stings Spider Bites

Black widow spider is identified by a red hourglass on its abdomen Only the female bites, and it has a neurotoxic venom

Initial pain is not severe, but severe local pain rapidly develops

Pain gradually spreads over entire body, more intense in abdomen and legs

Some symptoms include: Abdominal cramps and progressive nausea Vomiting Rash may occur Weakness, tremors, sweating and salivation

Symptoms begin to regress after several hours; usually gone in a few days Funnel web spider is a large brown or gray spider found in Australia

Symptoms and treatment are same as for black widow Brown house or recluse spider is a small, light brown spider identified by a dark

brown violin on its back

7. Bites and Stings Spider Bites (continued)

Brown house or recluse spider is a small, light brown spider identified by a dark brown violin on its back

There is no, or so little pain, that usually a victim is not aware of the bite Within a few hours a painful red area with a blotch blue center appears The outstanding characteristic of the brown recluse bite is an ulcer that does

not heal but persists for weeks or months Victim will experience fever, chills, joint pain, vomiting, and a generalized

rash. This occurs in children or weak and tired persons Tarantulas are large, hairy spiders found mainly in the tropics

Pain and bleeding are certain, and infection is likely Treat tarantula bite as for any open wound => Try to prevent infection If symptoms of poisoning appear, treat as you would a black widow

7. Bites and Stings Scorpion Stings

Scorpions are all poisonous, some more than others Death is rare, occurring mainly in children and adults with high blood pressure

or illnesses Treat sting same as a black widow Two different reactions, depending on the species

Severe local reactions only, with pain/swelling around sting area

Possible prickly sensation around mouth and a thick-tongue feeling

Severe systematic (whole body) reaction

Little or no visible local reaction around the sting area

Possible reactions:

Breathing difficulties

Thick-tongue feeling

Body spasms

Drooling

Gastric distention

Double vision, blindness, involuntary rapid movement of eyeballs

7. Bites and Stings Snakebites

Death from snakebites is rare

50% of the snakebite victims have little or no poisoning

25% develop serious systemic poisoning

Before treating a snakebite, determine if snake was poisonous

Bites from poisonous snake may have rows of teeth showing, but will have one or more distinctive puncture marks caused by the fangs

Symptoms of poisonous bite may include:

Pain at bite area

Swelling at bite area within a few minutes or up to 2 hours later

Spontaneous bleeding from the nose and anus

Blood in the urine

Symptoms of neurotoxic venoms usually appear 1.5 to 2 hours after bite:

Breathing difficulty

Paralysis

Weakness

Twitching

Numbness

8. Vital Injuries Head Injuries

Pose additional problems related to brain damage and spinal column injury

Can also interfere with breathing and eating

Try to limit range of motion of the head

Bleeding is more heavy flowing in the face and head area

Infections have more difficulty taking hold

If open head wound, cover injury with clean dressing

Do not attempt to dam bleeding from open skull fracture or ear canals

Watch for changes in mental status – indicates condition may be worsening

Reduce inter-cranial pressure by elevating upper body or dropping legs

Transport is a priority

8. Vital Injuries Abdominal Wounds

Particularly serious in survival situations

Extremely high mortality rate

Renders victim totally unable to care for themselves

If intestines are not coming out through the wound, a secure bandage should be applied to keep this from occurring

If intestines are coming out:

Do not replace due to almost certain fatal peritonitis

Victim should lie on back with knee bent towards chest

Avoid any motions that increase intra-abdominal pressure which might cause more intestine to come out

Cover with clean dressing after soaking it with saline or sterile water

Cover with an occlusive dressing such as plastic wrap

Cover victim with blanket or insulating wrap to preserve body heat

Treat for shock

“Nature” will eventually take care of the problem, either through death, or walling-off of damaged area

8. Vital Injuries Chest Injuries

Common, painful and disabling – can be life threatening

Severe bruises of chest or rib fractures require that the chest be immobilized to prevent large painful movements of the chest wall

Fractured ribs may prevent patient from taking full breaths

Apply bandage while the patient deeply exhales

If a “flail” segment is noticed, stabilize that injured area by using a pillow or patients arm and securing it with a belt, duct tape, etc (effectively splints the flail segment)

Sucking Chest Wounds

Easily recognized by the sucking noise and appearance of foam or bubbles in the wound

Wound must be closed immediately before serious respiratory and circulatory complications occur

Eye Injuries

Serious in survival situation due to pain and interference with other survival functions

More serious eye injuries involving disruption of the contents of the orbit may require that the lids of the affected eye be taped closed or covered to prevent infection

Thorns and Splinters

Frequently encountered in survival situations

Reduce their danger by wearing gloves and proper footgear

9. Environmental Injuries Heatstroke

Breakdown of body’s heat regulatory system

Body temperature more than 105ºF

TRUE MEDICAL EMERGENCY: 20-80 % fatality rate

Signs and symptoms include:

Swollen, beet-red face

Reddened whites of eyes

Not sweating

Unnatural paleness or absence of color in the skin

Bluish color to lips and nail beds

Cool skin

Treatment

Remove victim to a cool environment immediately

Remove as much clothing as possible

Pour tepid (cool, not cold) over vitim to effect cooling

Place cold packs on victim’s groin, sides of neck and armpits

Aggressively fan to promote evaporative cololing

Treat for shock as needed

9. Environmental Injuries Hypothermia

Body’s failure to maintain normal body temperature

Caused by exposure to cool or cold temperature over a short or long time

Body temps falls below 95 degrees

Can develop in air temps less than 65 degrees (or as high as 72 degrees if elderly)

Signs of hypothermia:

Shivering

Decreased muscle function (fine motor skills, then larger muscles)

Decreased level of mental responsiveness

Decreased vital signs

Then death

Treatment:

Prevent further heat loss

Rewarm as quickly as possible

Remove any wet clothing, dry the victim, then into dry clothing

Handle victim gently due to possible heart anomalies

Provide warm fluids if possible

9. Environmental Injuries Diarrhea

Common ailment

Can be caused by:

Change of water and food

Drinking contaminated water

Eating spoiled food

Becoming fatigued

Using dirty dishes

You can avoid most of these causes by practicing preventive medicine

Intestinal Parasites

Usually avoided with preventive measures => Example: Never go barefoot

Most effective prevention is to avoid uncooked meat and raw vegetables contaminated by raw sewage or human waste which was used as a fertilizer