2.2 Heat syncope: heat exhaustion or sunstroke

Both maladies tend to occur during heavy exercise in high humidity, or with inadequate water. Some chronically ill persons enter these state normally.

The basic symptom of heat syncope is a body temperature above 40°C (104°F) with fainting, or weakness but without mental confusion. If unconsciousness, confusion or convulsions are present, it is sunstroke which is rarer, but far more severe condition, a true medical emergency.

Note that some authorities do not distinguish heat syncope from sunstroke, and treat heat syncope as sunstroke in order to be safe. All authorities recognize that these are stages in the same process.

Heat syncope is caused by mild overheating with inadequate water or salt. In young persons, it is far more common than true sunstroke. Blood pressure is lowered when the body dilates (widens) capillaries (small blood vessels) in the skin to radiate heat. Also, water is evaporated from the blood, reducing the blood's volume and therefore lowering blood pressure further. The result is less blood to the brain, causing light-headedness and fainting.

The basic treatment for heat syncope is to treat it like fainting: Have the victim sit, if sitting lay down, if laying down, raise legs. Then, administer water, and oral rehydration salt , slowly, and move the victim to a cooler area.

With sunstroke, cool the victim. Remove their clothing, shade them, fan them and sponge with cool water. Massage limbs vigorously to move cooled blood into the body cavity. Ice or alcohol can cause damage. Get help immediately. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability.

2.3 Cramps

There are two basic causes of cramping. One is inadequate oxygenation of muscle, and the other is lack of water or salt. Cramps from poor oxygenation can be improved by rapid deep breathing, and stretching the muscle. Cramps from lack of salt and water can be treated by stretching the muscle, drinking water and eating salt. Pounding on the muscle can increase soreness.

What happens in a cramp is that lactic acid builds up because of normal anaerobic muscle metabolism. When the muscle burns sugar without enough oxygen, it makes lactic acid. The lactic acid finally becomes concentrated enough to trigger the contraction of the muscle. When the muscle lacks salt, the nerves firing the muscle are unable to recharge properly, causing a similar effect.

2.4 Insect and animal biteA bite is a wound received from the mouth of an animal. Bite wounds raise a number of issues from the viewpoint of medicine in addition to the physical wounds they leave, including the possibility of: poison infection by bacteria or other pathogens; and rs

Most animal bites should be considered as possible sources of infection, including rabiesThis article is about the infectious disease. For the 1989 album by industrial band Skinny Puppy, see Rabies (album). Rabies (from a Latin word meaning rage , is a viral disease that causes acute encephalitis in animals and people. It can affect most spec. Wash the wound, ideally with povidone iodine soap. Loosely bandage it, and do not suture it. Know the poisonous animals in your area.

Animal bites by carnivores other than rodents should be considered possible cases of Rabies. If you are bitten, try to capture alive or kill the animal and preserve its head. Look for signs of Rabies (foaming mouth, self-mutiliation, growling, jerky behavior, red eyes). If the animal lives for ten days and does not develop rabies, then no infection has probably occurred. The head can later be analyzed to detect the disease.

If the animal is gone, prophylactic Rabies treatment is recommended in most places. Certain places, such as Hawaii, are known not to have native Rabies. Treatment is generally available in North America, Britain and the Northern European states. Away from these areas, try to get to the nearest embassy of one of these states and indicate an acute medical emergency. The embassy doctor is usually willing and able to help.

Many snake-bitesA snakebite is, of course, the bite of a snake, often a venomous one. Most snake species are not venomous. Some venomous snakes are capable of biting without injecting poison into the victim, and such snakes will often deliver such a 'dry bite' rather tha, even by poisonous snakeAcrochordidae Aniliidae Anomalepididae Anomochilidae Atractaspididae Boidae Bolyeriidae Colubridae Cylindrophiidae Elapidae Hydrophiidae Leptotyphlopidae Loxocemidae Pythonidae Tropidophiidae Typhlopidae Uropeltidae Viperidae Xenopeltidae Snakes are colds, are not envenomed, and these can be treated as animal bites. Croatilid ( rattlesnakeRattlesnakes : Animalia : Chordata : Reptilia : Squamata : Viperidae Genera Crotalus Sistrurus Species about 30 Rattlesnakes are a group of venomous New World snakes, genera Crotalus and Sistrurus which have a small noise-making jointed rattle on their ta and pit-viper) venoms cause the bitten area to turn green or purple. Elapsid (coral and monay other non-U.S. snakes) venoms cause swollen lymph nodes. If symptoms appear, they should be treated by compressing and cooling the bite, and evacuating the victim, on a litter if possible. If available, antivenin should be administered. See below for phone numbers to locate antivenins.

The black widow spiderFor the Chechen rebel group see Black Widows. The black widow spider Latrodectus mactans is notorious for its neurotoxic venom. It is a large widow spider found throughout the world and commonly associated with urban habitats or agricultural areas. Althou, and some scorpions are dangerous mostly to small children and elderly adults. Only the Sydney funnel-web spider of Australia is frequently dangerous to adults, and it resides only within 100 miles of Sydney Australia. Treat as snake-bite. Antivenins are available in the U.S. for black widow spiders and the dangerous scorpions native to the U.S.

To locate antivenins, the Anti-venin index in Oklahoma City, Oklahoma, USA (1-405-271-5454) maintains a 24-hour hotline to help locate rare antivenins. Another possible number is the Poisondex central office in Denver, Colorado, USA (1-800-332-3073). In Australia, contact Commonwealth Serum Laboratories, Parkville, Victoria. In Asia try Haffkine Biopharmaceutical Corporation, Parel, Bombay, India. In Africa try the South African Institute for Medical Research, Johannesburg, Republic of South Africa. In most moderately developed countries, the national hospital can treat local poisonous bites.

2.5 Anaphylactic shock

Main article: Anaphylactic shock

Insect bites as well as exposure to allergens can trigger anaphylaxis in some people. Anaphylaxis is a life-threatening medical emergency because of rapid constriction of the airway, often within minutes of onset. Call for help immediately. First aid for anaphylaxis consists of obtaining advanced medical care at once; rescue breathing (a skill that is part of CPR) is likely to be ineffective but should be attempted if the victim stops breathing. Look to see if a device such as an Epi-pen is available for administration of epinephrine by a layperson.

2.6 Altitude sickness

Main article: Altitude sickness

Altitude sickness can begin in susceptible people as low as 8,000ft. The early symptoms are drowsiness, feeling unwell, and weakness, especially during exercise. More severe symptoms are headache, poor sleep, persistent rapid pulse, nausea and sometimes vomiting, especially in children. More severe symptoms include pulmonary edema (fluid in the lungs- persistent coughing), confusion, psychosis, hallucination and death.

Victims can sometimes control mild altitude sickness by consciously taking ten to twelve rapid large breaths every five minutes. If overdone, this can blowoff too much carbon dioxide and cause tingling estremities. The quickest cure is to reduce the victim's altitude if possible. Some mountain rescue groups carry acetazolamide (a prescription drug) to treat mountain sickness, injectable steroids to reduce pulmonary edema, and inflatable pressure vessels to relieve and evacuate severe mountain-sick persons.

Altitude acclimatization has two stages. Overnight, the body can adjust its carbonic acid balance, and substantially improve its performace. Over four to six weeks, the body can grow more blood cells, strengthen the heart and make other tissue changes. Above 18,000ft, further altitude exposure weakens one, rather than strengthening one's acclimation.

2.7 Wounds

Wounds with spurting bright red blood need immediate pressure to stop the bleeding. If neccessay, you may need to use your finger to push on the bleeding artery.

Follow this with a pressure bandage so you can rest, but make sure the wound is not continuing to bleed into the bangage. Oozing, slower wounds can be treated the same way, but it's reasonable to clean them first.

Antibiotic ointment, if available, is helpful if medical care is many hours away. It should be spread freely on wounds. Some authorities even advocate gently packing it into deep, dirty, slowly-bleeding wounds.

Some authorities believe that it is better not to change dressings, if the dressing change does not include good quality cleaning and debridement. Otherwise, dressings should be changed at least daily.

If sterile normal saline is available, it is useful for rinsing most dirt out of wounds.

Regardless of the severity of the wound, proper cleaning and disinfection is essential on longer stays in the wildnerness where an evacuation is not deemed necessary or is not possible. Relatively harmless local infections at the wound site can quickly escalate into life-threatening systemic infections if proper care is not taken. Some WFA courses provide instruction on the proper administering of antibiotic drugs to help treat serious infections.

2.8 Sucking wounds (of chest)

See tension pneumothorax. A person with a penetrating chest wound is experiencing a life-threatening medical emergency and needs immediate access to advanced medical care and equipment to save their life. One standard first-aid treatment is to cover the wound with a pressure bandage made air-tight with petroleum jelly or clean plastic sheeting. It is important not to completely close off the opening. Leave a flap or corner open so that air does not build up in the lungs yet the patient can still breathe.

2.9 Broken bones

Stabilize the break with splints, and move the injured party as little as possible unless they are certain to die from lack of shelter or care. The object is to prevent the bone from causing more injuries. If the skin is broken, treat it as a major wound.

Broken ribs are stabilized with tape. A person with a broken arm, collarbone or ribs can often be stabilized enough to walk out, however large amounts of pain indicate this is a bad idea. Waxed cardboard splints are inexpensive, very lightweight, quite waterproof and quite strong.

2.10 Tooth ache

The basic treatment is oil of cloves on packing in the sore tooth to reduce the pain. Systemic antibiotics and analgesic such as acetaminophen ( paracetamol) or NSAIDs may also help if available. Although teeth may hurt terribly, most severe tooth infections simply result either in a dead tooth, or a tooth that falls out and are rarely life-threatening.

2.11 CPR (Cardio-Pulmonary Resuscitation)

Sometimes you should not perform CPR, particularly if other persons are injured and need immediate help. CPR takes a lot of effort, and may keep you from helping others. See triage.

CPR is often portrayed in movies and television as being highly effective in rususcitating a person who is not breathing and has no circulation. A 1996 study by the New England Journal of Medicine showed that CPR success rates in television shows was 75%. The reality is that CPR administered outside hospitals has a 2-15% success rate on its own, and is most importantly used to sustain oxygen supply to the brain until specialized medical equipment and personel can reach the scene (see defibrillator).

If you are performing CPR in the wilderness, you may want to stop:

1. when a competent health professional takes responsibility for the patient;
2. if the patient is stiff and is obviously dead;
3. after twenty minutes of CPR with no pulse or breathing, and professional medical assistance will not be available for some time; in this case the patient survival in the wilderness is unlikely, unless hypothermic (then the patient needs to be warm, pulseless and unresponsive before being declared dead); or
4. when the rescuers are in danger.

First aid

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