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

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Wilderness and Rescue Medicine

side of the body or the sudden loss of the ability to speak. In some cases, the symptoms are tran- sient, resolving after a few minutes or hours as a clot forms and then dissolves. These transient ischemic attacks should be taken as a warning of serious and permanent problems to come if the patient is not treated soon. Like a heart attack, a stroke is an example of ischemia leading to infarction in a critical body system. It is a serious problem with a critical system, and the patient needs a hospital. During evacuation, apply BLS and treat as you would any patient with existing or anticipated increased ICP. Do not give aspirin or ibuprofen in an effort to reduce clotting. The stroke may be caused by bleeding and you will have no way of knowing that in the field. Seizure Seizure is a symptom of brain malfunction, not a disease unto itself. In the wilderness context, sei- zure may occur with low blood sugar, heat stroke, hypoxia, increased ICP, lightning injury, HACE, toxins, or hyponatremia. You will recognize this list from the STOPEATS mnemonic. The problem may be relatively mild or very severe. Either way, the new onset of seizure activity indicates nervous system problems that may become significantly worse over time. Of course, seizure can also be a relatively benign occurrence in a patient with a known seizure dis- order such as epilepsy. The stress of backcountry travel or a voyage at sea can upset the blood levels of antiseizure medication allowing a breakthrough event. This is a surprisingly common problem in the backcountry. The medical practitioner should be alert to this possibility when a seizure occurs without an obvious mechanism of injury. With organized trips or outdoors schools it is possible that a patient with epilepsy will have chosen not to disclose this history on an intake medical form. There are many types of seizures. The classic grand mal seizure is what you are most likely to notice easily and is characterized by generalized tensing of all body muscles and repetitive, pur- poseless movement. Although the eyes may be

open the patient will be unresponsive during the seizure. He or she may be incontinent of feces and urine. There will usually be a period of drowsiness and disorientation afer the seizure has ended. Treatment of Seizure Protection from injury is the most important treatment you can provide. Most seizures will resolve spontaneously in a short period of time. Protect the patient from injury when falling or thrashing. Also protect the patient from unneces- sary treatments like chest compressions or rescu- ers trying to force objects between the patient’s teeth. Seizing patients will normally hold their breath briefly and become cyanotic (blue from lack of oxygenation). This is not a problem if it does not last more than a couple of minutes. Position the patient and ventilate if necessary after the seizure has resolved, or during the seizure if you feel that respirations are inadequate. The real worry is not the seizure itself but what may have caused it.

Seizure Wilderness Perspective

General Principles

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High Risk Problem: • Result of trauma or environmental illness • Persistent neurological deficit

• New onset seizure • Recurrent seizure • The patient is getting worse

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“The real worry, of course, is not the seizure itself but what may have caused it.”

©2018WMA

If the mechanism is not obvious, consider all the conditions on the STOPEATS mnemonic. In the field you may be able to treat for problems like hyponatremia, hypoglycemia, heat stroke, and alcohol withdrawal. A careful survey of the scene may disclose problems like drug overdose, trauma, or hypoxia. Sometimes, people will experience brief seizure activity with head injury at the time of impact. This seems to be more common in children and is not serious if it resolves quickly and there is an early return of normal mental status. However,