A 35 year-old man hits a tree while skiing out of bounds. Bill is awake, alert, and reliable but fails your focused spine assessment due to cervical pain (8) and tenderness with no neurological deficit. Ski patrol is available to assist with transport via a Cascade toboggan and snow mobile. Estimated arrival to scene is 45 minutes and transport to an ambulance is expected to take another two hours with arrival at a local hospital in another hour. Total response and transport time to the hospital is estimated at roughly ± 4 hours. The outside temperature is 22º F and the patient has additional thermal layers in his pack. His remaining injuries are compatible with self-evacuation. Should you keep him quite and immobile and wait for help or begin a self-evacuation. Click here to find out. Click here to read a blog article on current spine management guidelines. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
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Geoff Jones, 52, is swept away in a medium sized soft snow avalanche while skiing in the backcountry. He travels approximately 400 feet and is recovered partially buried. He is awake, alert, and reliable with cervical spine pain and tenderness. He reports a tingling, electric-like pain in his right arm when his neck moves; he cannot distinguish between pinprick pain and light touch on his right hand; and, there is noticeable weakness on his right side when executing the motor exams on his hands. His remaining injuries are compatible with self-evacuation. There is no cell service and no one in the group is carrying bivy equipment with them or on their snowmobiles six miles away. Help is roughly twelve hours away. It's 3:30 pm in mid-January; sunset is within the next hour. The current air temperature is 21º F. Clouds are moving in, the wind is picking up, and it looks like it's going to snow. Should you keep Geoff quiet and immobile and go for help or begin a self-evacuation? Click here for answers. Click here to read a blog article on current spine management guidelines.
Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. Fleas, mosquitoes, lice, assassin bugs, sand flies, chiggers, ticks and other biting insects may be carriers of an infectious disease. With the advent of global warming, insects and insect-borne infectious diseases are spreading to new areas. To protect yourself against contracting an insect-borne infectious disease, the Centers for Disease Control and Prevention (CDC) recommends using the following insect repellents and insecticides; they have been shown to be safe and effective, even in pregnant and breastfeeding women. Clothing, tents, and mosquito netting are ideal for first order of protection and sleeping, especially when saturated with Permethrin (which kills insects on contact). To protect against chiggers and ticks, wear light-colored or white long pants, long-sleeved shirts, and socks so ticks can be more easily seen; pull socks over pant cuffs. Wear a hat and place petroleum jelly around hairline to keep ticks from crawling into hair (where they will be very difficult to find). Do a thorough tick check each morning & evening before entering and leaving your tent. The CDC does not recommend other insect repellents and products as they have not been shown to be effective despite manufacturers claims. These include natural plant oils, (such as citronella oil, cedar oil, geranium oil (or geraniol), and lemongrass oil), repellents containing vitamin B1 or garlic, and wristbands and ultrasonic devices. Application
DEET
Picaridin
IR3535
Lemon Eucalyptus Oil
Permethrin
Interested in learning first aid? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. You are leading a week-long backpacking trip for a local high school. During the night a cold front with high winds passed through breaking tree limbs and blowing down trees. A six-inch limb split off an overhead tree and landed on a student tent, hitting one of the students a glancing blow on his head while in his sleeping bag. When questioned, James said the storm had just woken him up when something hit the tent, collapsed it, and hit him in the head through his sleeping bag. The commotion woke his tent mate and together they managed to push the branch off the tent. They came to get you because James said he had a headache and a big lump on his head. Other than the lump and a headache (3), James says he feels okay. He has no spine pain or mid-line spinal tenderness, normal motor and sensory exams on his hands and feet, and no tingling or electric shooting pain in his arms or legs. His skull feels intact beneath the swelling. What is wrong with James and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. While paddling a Class V section on the Wind River in WA, a 35 year-old intermediate kayaker turned over in a rocky rapid. While upside down, Jamie hit his face and head against a boulder before being scraped out of his boat. He was rescued by his friends unresponsive and with a pulse, but not breathing. He started breathing spontaneously after one of his friends delivered a few rescue breaths. Five minutes later he awakened with a severe headache (7) and no memory of the event. Jamie's neck is stiff and painful (4) with mid-line spinal tenderness at C-3 and a tingling, electric-like pain shooting down his right arm whenever he moves his head. He appears somewhat stunned or dazed and reports numbness in his upper lip and gums and difficulty breathing through his nose. His nose is both painful (4) and tender. He is able to stand but has difficulty with his balance and walking. What is wrong with Jamie and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. Similar to patients with skull fractures, patients with an orbital, zygomatic (cheek), nasal, maxillary (mid face), or mandibular (jaw) fracture should be evaluated for a concussion, increased ICP, and a cervical spine injury. Patients with nasal, maxillary, and mandibular fractures may present with or develop airway management problems. Orbital Fractures Orbital Fracture S/Sx
Zygomatic (cheek) Fractures Zygomatic Fracture S/Sx
Nasal Fractures Nasal Fracture S/Sx
Maxillary (mid face) Fracture Maxillary Fracture S/Sx
Mandibular (jaw) Fracture Mandibular Fracture S/Sx
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
The mechanism of injury is clearly head trauma. All patients with a skull fracture should be evaluated for a concussion, increased ICP, and a cervical spine injury, and treated accordingly. Not all patients with a skull fracture present with a loss of consciousness and not all skull fractures require surgery. Exercise caution during the physical exam to avoid compressing a fractured area and further damaging brain tissue. A fracture in conjunction with an overlying wound, or one that communicates with the paranasal sinuses or middle ear often leads to meningitis. Skull Fracture S/Sx
Skull Fracture Treatment
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
Drowning & Traumatic Injuries While the majority of SUP drowning victims were novices not wearing a life-jacket, at least one drowning victim has died on a river when her leash snagged on hidden debris. Death from head injuries is also a concern when examining surf related accidents. And finally, mild traumatic knee and elbow injuries have occurred in whitewater paddlers. Interestingly, much of the protection available is controversial: The pros and cons of wearing, a leash, helmet, or knee & elbow pads are discussed below. To Wear or Not to Wear...a Leash Purchasing and wearing a leash with your paddle board should NOT be a forgone conclusion but it should be a serious consideration. Your board floats. If you don't wear a life-jacket, you will want to keep your board handy. A leash in flat, calm, protected water, especially for novices, may not be necessary and may well impede learning. On the other hand, wearing a leash while touring, in waves, or surf is usually a pretty good idea and will save you a long swim, or worse, should you fall off your board in heavy surf, strong current, or high wind. Wearing a leash in whitewater is a bit controversial. If you spend a lot of time surfing or running high volume rivers, consider a leash. If you run creeks and small rivers with debris and/or mid-river rocks, you probably shouldn't wear one as it increases your chances of entrapment. If you do choose to wear a leash in whitewater, you'll want one that clips to your life-jacket or waist (not your ankle or knee as these are difficult to reach in strong current), has quick release and break-away functions, and practice using it in strong current. If you choose to wear a leash in flat-water or surf and don't typically wear a life-jacket, you'll likely want one that attaches to your ankle or knee. To Wear or Not to Wear...a Life-jacket While wearing a life-jacket definitely increases your safety, they are somewhat constraining, are hot in the summer, interfere with tan-lines, and are therefore, controversial. Your choice to wear one (or not) depends on your paddling background and your risk assessment: Surfers tend to shun life-jackets and rely on their swimming ability and their board's floatation for protection; whitewater paddlers tend to bring and put on a life-jacket out of force of habit; and novices tend to wear what their instructor or friends wear. Manufacturers try to address comfort via design; inflatable life-jackets stored in belt-packs and activated by a pull-tab are available. No life-jacket will maintain an unresponsive person face up in rough water. NOTE: Many states consider paddle boards a water craft and require operators to either wear a life-jacket or have one on board; some states require board to have lights if used after dark. To Wear or Not to Wear...a Helmet Over the years, people have started to wear helmets in lots of sports where they didn't used to: biking, skate boarding, and skiing to name a few...so why not with an SUP? There have been head injuries and deaths in the surfing community (primarily from hitting their board) yet most surfers shun helmets in the same way they do life-jackets. This trend carries over to SUPs. Conversely whitewater paddlers have grown accustomed to wearing a helmet; after all, if you paddle a kayak or C-1, you are essentially tied into your boat with thigh braces and a spray skirt, and being upside down with rocks coming at your head seems to suggest, even to the most brain dead, that a helmet is a good idea. Again, this trend carries over to SUPs. Flat water canoeists and kayakers typically don't wear helmets (not much momentum if you aren't be pushed around by the water) and, once again, this trend carries over to SUPs. Should you wear a helmet? The answer is easy if you've had a previous head injury and are paddling in surf or whitewater: Wear one. Period. For everyone else, it's controversial. You need to make a personal risk assessment and then a decision. Base both on the likelihood of falling and hitting your head (on the board or something else). The bottom line is that it's safer to paddle with a helmet in the surf and whitewater, than not. To Wear or Not to Wear...Body Armor What? Wear body armor? Are you serious? Well, yes, on whitewater (or if you kneel on your board a lot). If you paddle on shallow rivers or tight rivers with lots of exposed rocks you should consider wearing knee and/or elbow pads. Also consider armored shorts with hip and sacral protection. Having your board stop suddenly after scraping the bottom on a rock tends to toss you forward onto the board or into rocks on the bottom of the river. Most paddlers land hard reasonably hard on their knees, elbows, hips, or back. All are somewhat fragile and hurt considerably when abruptly contacting a rock. Pads protect them. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
Introduction Stand up paddle boarding has taken off everywhere there's water: on flat-water, in the surf, and on whitewater. With it come a number of potential problems. Correctly touted as an excellent core workout, a discussion of effective training methods and possible injuries are often overlooked...until something starts to hurt. By then it's too late. Overuse injuries are common. While the overuse injuries in SUP are similar to other paddle sports, they are are exacerbated by the increased leverage of the paddle and the standing position. In order to propel the board forward force must be transmitted from the paddle through the paddler's entire body. Joints are the week points: wrists, elbows, shoulders, back, knees, and ankles. The exact process that makes stand up paddling so good for your core also makes it potentially bad for your joints. There are six things you need to consider when training/paddling SUPs:
Your Paddle You can reduce the strain on your joints by decreasing the length of your paddle, choosing a more flexible paddle shaft, and choosing a small blade size. Decreasing the paddle length directly reduces the size of the lever and therefore the strain on your body. In addition, a shorter paddle lowers your top hand and directly reduces forces on your rotator cuff, shoulder tendons, and cervical spine compression. That said, you don't want a paddle that is too short either as this will cause you to bend over more and increase the strain on your lower back. A flexible paddle shaft absorbs some of the explosive energy during the catch phase of a stroke and spreads the energy release throughout the stroke's length; this dramatically decreases the initial impact on your joints and the potential for damage. Alternatives to carbon-fiber (the stiffest) and fiber-glass blades (next in line) are wood and bamboo. A smaller blade size reduces the surface area of the blade and the amount of energy required for each stroke. While you can purchase smaller blades commercially, you can also cut down the size of your current blade with a jig saw (remember to smooth/sand the edges if you work on your own paddle). Your Body Each individual is unique. Injuries, age, fitness, strength, and flexibility all play an important part in determining what kind of paddling you choose to do and how you approach doing it. For instance, if you have low back problems, it's a better choice to paddle on flat water than in strong whitewater or surf as the sudden movements required for either whitewater paddling or surfing will increase the likelihood of low back injury as you attempt to react to the required changes. Don't ignore your body's history or what it tells you as you paddle and after. Technique Learning the proper paddling technique and paddling on both sides of your board is vital to preventing overuse injuries. Your muscles are designed to be in balance and, in order to prevent injury, you need to keep it that way by learning to paddle correctly on both sides of your board. This may be more difficult that it sounds when surfing or paddling in whitewater as paddlers tend to favor one side or the other. Strength & Flexibility Training If you want to paddle on a regular basis, you'll benefit by spending some time cross-training to avoid injuries. A quick web-search will reveal a number of SUP specific training regimes; one is sure to meet your needs. The Type of Paddling You Do Paddling SUPs on flat-water, in the surf, and on whitewater requires different equipment and skills. The forces on your body are different as well. This means that the types of injuries you can sustain are somewhat specific to the type of paddling you do. Flat-water paddling is typically limited to overuse injuries. While surf and whitewater paddlers are also susceptible to the same overuse injuries as flat-water paddling, moving water is strong and paddling in it increases the chances of muscle and tendon damage; furthermore, traumatic injuries and drowning are also possible. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
You and two friends are riding an old mountain bike race course when you reach a gnarly downhill section. You elect to slide down the section with your bike and take photos. One of your friends manages to successfully ride down. Unfortunately Jack hits his front breaks too hard, flies over the handlebars landing on his head, neck, and shoulders, then slides with his bike another 50 feet to an open, dry wash at the bottom of the slope. When you reach him, he is sitting up holding his side and having difficulty catching his breath. After a few minutes, he calms down and is able to breath as long as he doesn't try to take a deep breath and breathes with his diaphragm. Jack's helmet is intact and he is able to recall his entire fall. He says he landed hard on his handlebars and thinks he broke a rib low on his left side. Road rash covers most of his back where his jacket slid up during his slide and small pieces of gravel is embedded under portions of his skin; it looks nasty but Jack said it doesn't really hurt. Jack's pulse rate is 88 and regular; his respiratory rate is 22 and easy; he reports that his normal pulse rate is in the low 50s. It's 3 pm, overcast and cool, about 50 degrees F; the sun sets about 7:30 pm. You have a small first aid kit, some water, food bars, but no additional clothing. Nighttime temperatures have been in the low 40s. You are roughly six miles from your vehicles over challenging terrain and another two hours to the nearest clinic. You have cell phone reception. What is wrong with Jack and what should you do? Click here to find out. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. |
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