Wilderness First Responder Study Guide

[I just received my Wilderness First Responder Certification from Wilderness Medical Associates. It’s a 70 hour 10 day course on backcountry medicine. I got the first 100% on the test in two years! Here’s the study guide I made and used. Good luck, stay safe!!!!]

It's official!
It’s official!

Wilderness First Responder Study Guide

Circulatory:

Shock: Inadequate perfusion pressure in the circulatory system, resulting in inadequate tissue oxygenation.

Types of Shock:

Cardiogenic: “Pump Failure”; Caused by heart attack, chest trauma, or heart disease.

S/Sx: Chest pain/pressure with radiation, ↑Respiratory Rate, Variable Pulse

Tx: One adult aspirin, nitroglycerin as prescribed, PROP, gentle evacuation

Vascular: “Vessel Dilation”; Caused by anaphylaxis, heat stroke, toxins, or systemic infection.

S/Sx: ↑ Respiratory Rate, ↑Heart Rate, ↓Urine Output, NO shell-core

Tx: Treat cause. Horizontal position, hydration.

Volume: “Fluid Loss”; Caused by loss of blood or other body fluids

S/Sx:  (Compensated) ↑Respiratory Rate, ↑Heart Rate, Shell Coring

(Decompensated)Very Rapid Heart+Respiratory Rate, ↓Level of Consciousness

Tx: Evacuate, Stop Volume Loss, Insulate, Hydrate, Elevate Legs

Nervous:

A change in mental status can be caused by trauma or by components of the STOPEATS acronym.

Traumatic Brain Injury (TBI):

S/Sx: Mechanism of injury + any loss of consciousness, amnesia, or, altered mental status.

Anticipated Problems: ↑Intracranial Pressure

Tx: Monitor for ↑ICP

Increased Intracranial Pressure (↑ICP):

S/Sx: Following a TBI; deterioration of mental status, persistent vomiting, or severe headache

Tx: Rapid Evacuation.

Sugars

Temperature

Oxygen

Pressure

Electricity (Seizures/Electrecution)

Altitude

Toxins

Salts

Respiratory:

Distress: Difficulty breathing, speaks in short sentences.

Failure: Only speaks 1-2 words at a time. A+Lethargic, V, or P on AVPU.

Arrest: No breathing. U on AVPU.

Parts of the system:

Upper Airway Problems: Blockages

Lower Airway Problems: Swelling due to irritant or histamine release. Spasm due to irritant (asthma).

Alveoli Problems:  Introduction of fluids (breathing water, blood, vomit) or other irritants.

Chest Wall Trauma: Multiple broken ribs, puncture wound.

Respiratory Drive Problems (Brain): Hyperventilation (temporary), drive decrease-STOPEATS that cause disruption in brain homeostasis.

Asthma:

Treatment for someone in respiratory distress with history of asthma:

  • Position best respiration

Reassurance, slow deep breathing

Oxygen, supplemental/seek best air

Positive pressure ventilations, Rescue Breathing if in Failure

  • Meter Dose Inhaler as needed

Treatment for someone in respiratory failure with history of asthma:

1st 0.3mg Epinephrine

2nd 6-10 puffs of Meter Dose Inhaler

3rd 40-60mg Prednisone

4th Evacuate

Wounds:

The anticipated problem with any wound is infection; therefore, aggressive wound cleaning is necessary.

Wound Cleaning:

1st Clean/scrub around the wound with clean water.

2nd Wipe around the wound with 10% iodine solution.

3rd Tweeze out any large objects in the wound.

4th Irrigate the wound with clean water and increasing pressure, tweeze as necessary.

5th Once clean, allow 1% iodine solution to “pee” into the wound (no pressure).

6th Dress wound with sterile gauze damp with 1% iodine, wrap lightly.

Infection:

S/Sx: Increasing redness, pain, warmth, swelling after 24 hours (Localized). Fever, malaise, regional swelling, red streaks, vascular/volume shock (Systemic).

Tx: Incise/drain abscess, irrigate/dress, allow drainage, hot soak x4 per day, antibiotics, evacuate (Localized). Aggressive hydration, antibiotics, sugar, PROP, urgent evacuation (Systemic).

Musculoskeletal:

Stable vs. Unstable: A MS injury is unstable if:  1. It can’t be moved, used, or bear weight

2. It is deformed

3. There is impaired CSM’s

Treatment for a stable MS injury: Rest Ice Compression Elevation (RICE), splint/sling for comfort, NSAID’s for pain/swelling, monitor CSM’s.

Treatment for an unstable MS injury: Splint in position found unless ischemia+deformity, insulate, hydrate+food, monitor CSM’s.

Dislocations: Method of Injury must be torque/leverage not impact/crush, palpate to ensure there are no broken bones (exquisite pain). Only field reduce shoulders (baseball position), patella’s (push medially as you straighten leg), and digits (TIP).

Thermoregulation:

Hypothermia:

Normal Cold Response S/Sx: Shivering, A+O.

Mild Hypothermia S/Sx: Mental status change (still Awake), strong shivering, shell-core. Tx: Rewarming, food+fluids, insulate.

Severe Hypothermia S/Sx: V,P, or U on AVPU scale, shell-core, no shivering

Tx: Aggressive rewarming, urgent but gentle evacuation, food+fluids when possible

Heat Illnesses:

Heat Exhaustion S/sx: Subdued mental status, core-shell (red skin), sweating. Tx: Fluids, food, cooling.

Heat Stroke S/sx: Big mental status changes, vital signs for volume shock. A’: Volume shock, ↑ICP. Tx: Aggressive cooling, fluids and food, evacuation (urgent if not improving).

Frostbite/Frostnip:

Frostnip S/Sx: Patient can feel his extremity (poke with knife), pale/red. Tx: Rewarm, protect from trauma/refreezing.

Frostbite S/Sx: Hard, pale or blue skin, no feeling with knife poke. Tx: Rewarm if; immediate evac is impossible and extremity will not be used, and refreezing can be prevented. 600-800mg ibuprofen, pain control, bandage/splint, antibiotics, evacuate ASAP.

Anaphylaxis:

A histamine response to an ingested, injected, inhaled, or absorbed antigen.

S/Sx: Respiratory distress, hives, altered mental status, tight scratchy throat.

Tx: 1st 0.3mg epinephrine 2nd 25-50mg Benadryl 3rd 40-60mg prednisone 4th evacuate

Protocols: 

Wilderness First Responders learn unique skills that can be performed under certain circumstances that urban professional rescuers cannot perform those skills are:

  1. The administration of prescription drugs for anaphylactic shock
  2. The administration of prescription drugs for severe asthma
  3. Reducing simple dislocations (shoulder, patella, digit)
  4. Assessing and clearing the spine
  5. Aggressive wound care and/or the removal of impaled objects
  6. Cessation of CPR after 30 minutes

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