Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section V: Environmental Medicine

permitted to swim or dive until the ear drum has healed. This usually takes several weeks to months. Serious problems can develop when the injury involves the inner ear or facial nerves. Early evacuation to medical care is indicated since there is no real field treatment.

water. A patient immobilized on a backboard or litter is completely helpless. Allowing your patient freedom of movement may risk exacerbating an injury but will be of substantial benefit if the raft or small boat capsizes.

General Principles

Middle Ear Barotrauma

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Signs and Symptoms: • Pain. • Impaired hearing. • Congestion. Red Flags: • Facial paralysis. • Hearing loss.

Inner ear

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• Tinnitis. • Vertigo. • Fever.

Middle ear sinus

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Mask squeeze develops from a failure to pressur- ize the air space in the face mask during descent. The relative increase in pressure in the vascular system and soft tissue under the mask can cause the rupture of small blood vessels in the con- junctiva of the eye and skin of the face and nose. Although scary looking, it is usually not serious. Treatment is directed at relieving symptoms. Risk Versus Benefit Water is a high-risk environment for the injured and the rescuers, especially if it is moving and cold. Water rescue offers an almost unlimited opportunity to create more patients and increase the scale of disaster. Mitigating the risks is the first step in rescue and resuscitation. Considerable training and practice are required. Unskilled res- cuers should remain ashore. A patient in the water is an unstable scene. In all but the most desperate situations, removal of the patient from the water comes before assessment and treatment. In-the-water spine stabilization, for example, is appropriate only in a heated pool with enough rescuers and scene control to ensure the safety of all involved, including the patient. Beware that your treatment does not inhibit your patient’s ability to survive in and around