Wilderness and Rescue Medicine 8th Edition

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Wilderness and Rescue Medicine

General Principles

General Principles

Most People Live

Anticipated Problem

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• First, do no harm • Watch critical systems and body core temperature • Keep yourself and your team safe

• Ischemia to Infarction • Obstruction to Infection • Compensated Shock to Decompensated Shock • Respiratory Distress to Respiratory Failure • Mild Hypothermia to Severe Hypothermia

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“A serious problem that you cannot fix will become an emergency.”

© 2018 WMA

© 2018 WMA

For example: My patient is in respiratory distress progressing toward respiratory failure. This is seri- ous. I can’t fix it. This is an emergency. We need to move fast and accept greater risk in evacuating this patient to medical care. Most People Live Curiously, the development of hospital-based imaging technologies like computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) have been very helpful to wilder- ness and rescue medicine. The ability to detect a spleen or kidney laceration and watch it stop bleeding and heal without surgery tells us that not everybody who ruptures an internal organ dies. As a result, very few injured spleens or kidneys are removed these days. With CT and ultrasound, we can watch appendi- citis stabilize and even resolve on oral antibiotics . Brain scans after trauma often reveal intracranial bleeding that causes no symptoms and resolves without permanent injury. While we don’t yet have widespread use of imaging equipment in the wilderness, what we have learned from its use in the hospital helps with our decision making, especially in more remote and dangerous places. Critical system injury is not a death sentence. If your patient survives the initial insult and the first fewminutes thereafter, they have a good chance of living to see another day. The body has an incred- ible ability to compensate for significant injury and overcome devastating illness. Our job is to support that effort without doing additional harm.

Critical system injury does not always demand a high-risk rescue. A hospital might be the ideal destination, but good basic life support and careful handling will give your patient a better chance of survival than a high-risk evacuation that injures them more in the process. Although an emergency evacuation is often the ideal plan, it is not always the real one.