Wilderness and Rescue Medicine 8th Edition

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Section III: Critical System Problems and Treatment

disrupt clot formation, and too much intrave nous fluid can impair coagulation and contrib ute to hypothermia. It is a delicate risk vs benefit balance. Another ALS option is a drug called tranexamic acid (TXA) which has been shown to reduce hem orrhage if given soon enough after the injury. It can be administered orally or by IV and works by inhibiting the breakdown of fibrin in clots. It is in use by some EMS systems in the U.S. and else where, particularly where access to surgery and blood products will be delayed. Nevertheless, for uncontrolled bleeding giving IV fluids and TXA in the field is less important than access to blood, a hospital, and a surgeon. If bleeding can be controlled quickly in the field while the patient is still compensating, the use of IV, subcutaneous, or even oral hydration therapy may help to restore intravascular volume and is less likely to be harmful. Shock stabilized like this, especially if patient protection and body core temperature is not an issue, becomes a lot less of an emergency. Evacuation can be slower and less hazardous. Brain Failure Changes in mental status or level of consciousness can be caused by direct trauma to the nervous system or by loss of brain oxygenation due to cir culatory or respiratory system problems. There is no real way to treat brain failure other than to treat the cause. Examples include giving sugar to reverse hypoglycemia or naloxone to reverse opioid overdose. Otherwise, BLS is aimed at pro tecting the airway from fluids and vomit while assessment and treatment continue. In trauma patients, the spine is also protected as part of BLS. This usually takes the form of restoring and maintaining normal spinal align ment while treatment of any life-threatening condition continues. However, spine management should not take precedence over patient protec tion, adequate ventilation, or circulatory support. A major critical system problem carries a high risk of death and the benefit to the patient of almost any BLS/ALS treatment is obvious. What

is less obvious, sometimes, is the risk to the rescu ers performing the treatment.

General Principles

BLS – Brain Failure

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Altered Mental Status: • Treat the cause – STOPEATS • Maintain normal body temperature • Secure and monitor the airway

• Maintain ventilation • Maintain hydration • Protect the spine as needed

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“ There is no real way to treat this other than to treat the cause .”

© 2018 WMA

Risk Versus Benefit in BLS Any rescue effort, even the most desperate, must consider the overall probability and consequence of an adverse event. Performing CPR under a hang fire avalanche, for example, is a very low yield procedure in a very high-risk environment. Discontinuing resuscitation under such a circum stance would certainly be appropriate but would be one of the most difficult decisions a medical officer would have to make.

External injury highlights the anticipated prob lem of internal bleeding. However, significant blunt force trauma may leave no visible signs. Even in the urban context, the global risks are often discounted in favor of low-yield procedures. Consider, for example, the AED-equipped police cruiser responding to a cardiac arrest call. The officer knows that a fast response is beneficial to the patient’s chance for survival. But, at the same time, their code 3 race through town substantially increases the risk to drivers on the road, children