Emergency Procedures?

[imported_mknutson]

Can someone please help me, and other, understand medical practices/procedures for dealing with a person in shock?
Also lets say the person is stuck on a ledge.
Maybe they have a radio, maybe not.

What should be said to them?
How could the situation be made better?
How could it be made worse? (just so I know what NOT to do)


What kind of things could I bring on a jump that are small, but could help in this situation?

--
Thanks

Mick Knutson
BLiNC Magazine

"Everything you ever wanted to know about BASE Jumping, but didn't know who to ask."
--

[guest]

A multiple part question. With some information to share none of which will be related to the medical topics.
But, with equipment and preparation I'll share a few ideas.
A radio, with the availability and cost it should be part of basic equipment. Communication during any jump is valuable information. The jump goes as planned radio communication is minimal. But when a jumps deviates from the plan it is invaluable.
As for some "small" safety equipment. Understanding basic rock climbing techniques and equipment will go far on any object strike where you need to stay instead of go. Several times people have been stranded on small ledges for several hours, include some of 12 hours on a ledge. A few slings (loop of tubular webbing) and a couple of carabiners. Would go a long in the preservation of life during these type of situations.
SaddleBags are a great place to keep such items. Which on occasion would include "small shelter," a rain poncho.
Just some quick thoughts.

Todd

[guest]

Hey Mick,some things I thought about carrying after Terrys death were:

a whistle
space blanket
firefly personal locator beacon(strobe light)
mobile phone(mine had a signal whilst at Kjerag)
motorola radio

you could go on all day about things like mini flares,pain killers etc etc but the ones above would certainly have helped in the situation at Kjerag...I suppose they are all really jump specific but I suppose they are a starting point.regards...

Sean

[guest]

Without intravenous fluids, only general supportive measures can be done in the wilderness theatre, to treat true "shock"...
Maintaining the jumper in a warm sheltered environment(sleeping bag) minimizing movement( as practical as can be with a rapid evac.), giving warm oral fluids if airway is stable and person is able to swallow purposefully, and a head down/feet up position will shift peripheral intravascular volume to the central circulation.
Without local rescue...or a delay greater than 8 hrs, lacerations should be irrigated, foreign bodies removed, fractures reduced and splinted, yaddy yaddy yadda..

Been there, it sucked!

[guest]

Mick, If I remember my First Aid correctly, clinical shock is a drastic drop in blood pressure. It is important to keep the victim warm, stop any bleeding using compression and allow gravity to help the heart by having them lie prone. It is also very important to maintain verbal contact/encouragement. A big part of the game is mental. If the victim gets panicked or senses despair shock will often follow. I wouldn't be surprised if shock has killed more soldiers in combat that bullets.


Adam Filippino

Consolidated Rigging, Inc.
http://www.crmojo.com

[guest]

Mick,

Shock is a vastly misunderstood condition by "laypersons" outside the EMS community. People do not just "go into shock" as is so often heard at emergency scenes. For your purposes, keep in mind a couple of factors. Shock is caused by any condition that severely reduces blood flow, thereby reducing blood pressure. If someone is truly in or very near "shock" this is a dire emergency and only immediate advanced medical attention can prevent damage to vital organs and tissues.
For someone suffering an object strike, the cause will be more than likely hypovolemic or loss of blood volume. This can be directly due to injury, or in the case of someone "ledged out" for an extended period of time, dehydration. Victims of shock can have many signs and symptoms such as, anxiety/nervousness, dizziness, faintness, nausea/vomiting, paleness, profuse sweating, rapid pulse, shallow breating, excessive thirst, weakness, and maybe most importantly confusion.
As far as treatment, if you are the victim, there's little that can be done short of stopping any external bleeding, and keeping warm. Assuming you have no cervical spine injuries, you could also assume the "shock position", lying on your back with your feet elevated about 12".
If someone else is the victim, there's also little you can do from a distance. Try to keep them calm, get them to stay warm, control bleeding, and discourage them from eating or drinking anything despite their strong desire to do so. While dehydration can be a cause of shock, it's unlikely someone would be stuck so long that this could be a factor. Also, in an object strike situation, the likelyhood of spinal injury is so great, any dramatic movement on their part could be disasterous, encourage them to lie as still as possible while treating the bleeding .
I would STRONGLY recommend that you, or any other serious outdoor enthusiast enroll in an EMT course, or at the very least a wilderness first responder program. The skills you aquire will literally save lives. Hope this helps. Good luck, stay safe.

[guest]

Again, case dependent. Dehydration, true, probably not a factor unless in 4 corners area. However, a femur fracture can result in a 2-3 unit blood loss into the surrounding tissues, and bilateral femur fractures could easily(and I've seen hundreds of times) lead to markedly decreased intravascular volume, tachycardia, hypotension with further increases in catecholamine releases and the shock state. Burgers aside, fluid resuscitation in any fashion will help in this scenario.
386

[guest]

Gotta go with Team Chestnut on this one, remembering that there are various types of shock (mechanisms)...Neurogenic, Hypovolemic, Septic...etc...needless to say fluid resuscitaion is of parmount concern. However, warm naked hugs from sweedish waitress' named Helga go along way.
Starting to feel a little woozy myself....HELGAAAAAAAAAAAAAAAA

[guest]

Frozen with fear or injured, the symptoms will be that same. The definition of shock is simply a perfusion/demand mismatch. The causes are: 1) psychogenic 2) neurogenic, from actual central nervous system injury 3) hypovolemia 4)cardiogenic, caused by chaotic electical activity resulting in hypotension 5) hypoglycemia, and 6) septic.

Symptoms of shock are:

1) altered mental status: confusion, restlessness, change in personality, hyperventilation, combativeness, even loss of consciousness.

2) skin signs: pale, cool, and sweaty. Caused by adrenalin constricting peripheral arteries and veins shunting blood to the central compartment.

3) low blood pressure: unless you have a cuff you can tell this by the skin and mental status. All the causes of shock cause the release of neurotransmitters which cause the central blood vessels to dilate, thereby dropping the blood pressure by increasing the size of the container in which the blood resides.

4) rapid pulse: baroreceptors throughout the body constantly monitor our pressure. When it drops even a bit our hearts are stimulated to beat faster to raise the pressure and prevent a decrease of bloodflow to our vital organs (shock).

5) thirst: results from the body thinking we're low on fluid. Relatively speaking, a person in shock always is and fluids are always benificial except when a person is nauseous and may vomit and then aspirate their vomitus secondary to altered mental status.

Treatment for psychogenic shock: Early evaluation, therefore prevention is best in hindsight, of course. Otherwise, do whatever it takes to prevent injury to the victim or would-be rescuers, including restraining the victim. You cannot talk sense to someone with an impaired cerebral blood supply! They are exactly like a diabetic who took his inulin but didn't eat. In effect, all persons in shock are hypoxic, hypoglycemic, and hypovolemic. Therefore, oxygen, sugar, and fluids are always indicated. But, how does one deliver any of these to a confused, combative person? There is no single answer.

I recommend the same approach I use with suicidal patients. Be gentil and non-threatening but be ready to be aggressive if restraint is required. Always use help if available. Confused people can be very strong.

Any more good questions, please contact me.


Jeff Bigler, paramedic
USPA D-2410
anchor@tiki.net

4) rapid pulse: baroreceptors thoughout the body detect low blood pressure and stimulate the heart to beat faster in an attempt to raise the blood pressure

[Nik]

"Frozen with fear or injured, the symptoms will be that same".

Lines do cross....similar, but not necessarily the same

386?