【模板】桥接 - WFR 学习指南5-Day WFR Study Guide

伤口和烧伤WOUNDS AND BURNS

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脱臼DISLOCATIONS

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严重过敏反应法则Anaphylaxis Protocol

处治伤害Treatment of Injuries

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蝮蛇Pit Vipers

循环系统CIRCULATORY SYSTEM

系统概括System Overview

系统概括System Overview

基础生命支持-工具和装备Basic Life Support – Tools and Equipment

生命体征Vital Signs

便秘Constipation

缺血和梗死Ischemia and Infarction

呼吸系统问题Respiratory System Problems

过敏和严重过敏反应ALLERGY AND ANAPHYLAXIS

列出在高海拔环境下面对的主要压力。List the primary stress confronted at altitude.

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寒冷伤COLD INJURIES

夹板原则Splinting Principles

中枢神经系统CENTRAL NERVOUS SYSTEM

SAMPLE 病史SAMPLE History

系统概括System Overview

毒素有哪四种方式进入身体？ What are the four ways that toxins enter the body?

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中风Stroke

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脊柱管理SPINE MANAGEMENT

基础生命支持-循环系统Basic Life Support – Circulatory System

蜱虫Ticks

系统概括System Overview

血管性休克Vascular Shock

耳部问题Ear Problems

糖尿病Diabetes

系统概括System Overview

肌肉骨骼MUSCULOSKELETAL

脊柱伤的评估Assessment of Spine injuries

基础生命支持-工具和装备Basic Life Support – Tools and Equipment

体温调节THERMOREGULATION

什么条件和因素会让人更容易造成冻伤？What conditions and factors predispose a person to frostbite?

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腹泻Diarrhea

问题：QUESTIONS:

首要评估Primary Assessment

系统概括System Overview

眼部问题Eye Problems

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淹没SUBMERSION

基础生命支持-呼吸系统Basic Life Support – Respiratory System

胸部疼痛Chest Pain

偏远地区医学BACKCOUNTRY MEDICINE

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腹部疼痛Abdominal Pain

低血糖HYPOGLYCEMIA

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列出HAPE不同阶段的体征，症状和处治。List the signs, symptoms, and treatment for the different stages of HAPE.

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呼吸系统感染Respiratory Infections

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尿路感染(UTI)Urinary Tract Infections (UTI)

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问题：QUESTIONS:

处治Treatment

案例学习Case Studies桥接(WAFA 到 WFR)5-Day WFR此学习指南意在协助你回顾国际野外医学协会的野外第一响应人(WFR)课程内容中的关键材料。其课本《野外与救援医学》涵盖了此学习指南中所有的材料。This Study guide is intended to aid you in review of key material included in the Wilderness Medical Associates First Responder (WFR) curriculum. The text book you will receive (Wilderness and Rescue Medicine) covers all of the material posed in this Study Guide.请阅读下列三个案例学习，并且回答接下来每个案例学习中的问题，并且对每个案例完成一份SOAP笔记。在做出评估和处治决定时，要记住野外医学的一般原则，还有WMAI的野外法则，以及考虑风险/收益的计算。Please read the following 6 case studies. Pick any two (2) and answer the questions that follow each case study and complete a SOAP note for each. Keep in mind the general principles of wilderness medicine, as well as WMA’s wilderness protocols, and consider risk/benefit calculations in your assessments and treatment decisions.将你三份写好的SOAP笔记和答案带到课堂上去，因为有可能第一天就要交上去。Bring your 2 written SOAP notes and answers to your course as they may be collected on the first day.

伤患评估系统PATIENT ASSESSMENT SYSTEM

评估伤害Assessment of Injuries

对所有的溺水伤患都应该CPR吗？解释为什么。Is CPR indicated on all drowning patients? Explain your answer:

流鼻血Nosebleed

哮喘ASTHMA

生理学和病理学的一般原则GENERAL PRINCIPLES OF PHYSIOLOGY AND PATHOLOGY

受伤脊柱的移动Movement of injured spines

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基础生命支持-呼吸系统Basic Life Support – Respiratory System

系统概括System Overview

低体温症Hypothermia

劳累性低血钠症Exertional Hyponatremia

基础生命支持-循环系统Basic Life Support – Circulatory System

概括局部反应和轻微过敏反应的处治：Outline the treatment for a local reaction and a mild allergic reaction:

基础生命支持-神经系统Basic Life Support – Nervous System

烧伤Burns

闪电LIGHTNING

BLS vs ALS

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直流电伤害-机制DC Injuries - Mechanism

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肿胀Swelling

氧合与灌注Oxygenation and Perfusion

恶心和呕吐Nausea and Vomiting

身体系统Body Systems

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海洋毒素Marine Toxins

溺水的主要问题是什么？如何处理？What is the primary problem with drowning and how is it managed?

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代偿机制Compensation Mechanisms

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身体检查Physical Exam

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心源性休克Cardiogenic Shock

次要评估Secondary Assessment

案例1：划船被蛰STING, PADDLING在里奥格兰德河上的一次白水皮划艇旅途中，一名18岁的女性在一处热门游玩地点处，沿着河岸踏出了她的船只。离开了船只后，她惨叫着挥舞着自己的手臂和双脚，同时她跳入了河岸边的浅水处。当她的同伴划船手到来时，她表示自己对蜜蜂过敏，并且在肩膀上被蛰咬了一次。On a whitewater canoeing trip down the Rio Grande River, an18 y/o female stepped from her boat along shore at a popular play spot. Upon exiting, she cried out and flailed her arms and legs as she jumped in the shallow water along the bank. When her fellow paddlers arrived, she stated that she was allergic to bees and she had just been stung, once, on her right shoulder.1300时，伤患主诉手臂和双脚极度瘙痒，而且对于自己在众人面前发生了过敏反应感到十分尴尬。她说她有对蜜蜂蛰咬的过敏反应病史，并且她表示在以前发生严重反应时，她必须得使用肾上腺素注射笔。她这次身上没有携带肾上腺素注射笔。体检时，伤患在胸口，后背和脸上起疹。她的眼皮明显肿胀。她的右后肩膀上可以看到一条红色的肿胀痕迹。她的生命体征如下：脉搏：100；呼吸30并且短促；皮肤：胸口，后背和脸部起疹；精神状态：醒着并且焦虑。At 1300 hours, the pt. complained of intense itchiness on her arms and legs and was extremely embarrassed to be having a reaction in front of others. She said she had a history of allergic reactions to bee stings, and she stated that she had had to use an Epi-pen in the past for severe reactions. She did not have an Epi-pen with her on this occasion. On exam the pt. presented with hives on her chest, back, and face; her eyelids were noticeably swollen. A red swollen welt on her right posterior shoulder could also be seen. Her vitals were as follows: Pulse: 100; Resp: 30 and shallow; Skin: hives on chest, back, face; mental status; awake and anxious.将上述故事中的合适信息填入SOAP笔记中的正确位置。Put the appropriate information from the above story into the correct spaces provided in the SOAP note.给出一份评估，识别出预期问题，并且基于你在1300时所知的情况，对伤患给出处治计划。Develop an Assessment, identify the anticipated problems, and create a treatment plan for this patient, based on what you know at 1300 hours.这位伤患很幸运，现场有一支可使用的肾上腺素注射笔。在1315时，使用了0.3mg肾上腺素和50mg的苯海拉明之后，伤患的病情显著好转。她的脸部没有那么浮肿，尽管疹子依旧存在，她表示皮肤没有那么痒了。1330时，伤患的疹子减少了。她没有表现出病情反复或是两相反应的体征。生命体征如下：脉搏：84；呼吸：16而且轻松；皮肤：轻微肿胀和起疹；精神状态：警觉而有判断力。Fortunately for this patient, an Epi-pen was available on scene. At 1315, after 0.3 mg of epinephrine and 50 mg of Benadryl was administered, the patient’s condition improved considerably. Her face was less swollen, and though hives were still present, she stated that her skin was less itchy. By 1330, the patient’s hives had decreased. She showed no signs of a rebound or biphasic reaction. Vitals were as follows: Pulse: 84; Resp: 16 and easy; Skin: minor swelling and hives; mental status: alert and oriented.修改你的SOAP笔记，以反应出伤患在1330时的变化。Modify your SOAP note to reflect the changes in your patient at 1330.如果现场没有药物可供使用，你对这个伤患的处置计划会如何改变？If no medication had been available on scene, how would this change your treatment plan for this patient?

精神状态与意识水平Mental Status and Level of Consciousness

问题：QUESTIONS:

抽搐发作Seizures

现场评估Scene Size-up

预防Prevention

哮喘法则Asthma Protocol

基础生命支持BASIC LIFE SUPPORT

CPR 法则CPR Protocol

为以下列出来的每个问题，列出预处理的评估标准和处治：List the pretreatment assessment criteria and treatment for each of the following:

评估Assessment

处治疼痛Treating Pain

案例2：徒步时被熊袭击BEAR ATTACK, HIKING在一个美丽的秋日，1500时，一个独行的徒步客决定进行一个短途徒步。在距离小路尽头不远处，他惊扰了一头棕熊，然后被熊咬了。三个在此区域内的徒步客在袭击发生之后很快发现了伤患。三人让一个小组成员回去寻找帮助，另外两人留下来照护伤患。At 1500, on a beautiful autumn day, a solo hiker decided to take a short hike. Not far from the trailhead he surprised a brown bear and ended up being mauled. Three other hikers who were in the area discovered the pt. soon after the attack. The three sent one of their group members to get help while the other two stayed behind to help take care of the pt.1700时，一个救援小组到达现场。经过询问，伤患表示熊咬了他手臂几次。然后熊咬了他的脚，将他的靴子拉掉了。伤患尝试过光脚走出去，但是没有靴子他不能够走出去。伤患主诉双手和右脚疼痛。他表示自己没有过敏史，没有定期服用的药物，也不记得自己上次注射破伤风疫苗是什么时候了。他这一天都有饮水和吃零食。他记得袭击的每个细节。体检后，发现伤患在两手前臂上有着四处刺孔/挤压伤，深度达2.5厘米。伤口造成了中等程度的失血，但是在体检时伤口已经不主动流血了。在伤患的右脚底部有一处7.5厘米长的非常浅的撕裂伤。伤患脸上和脖子上有血迹，但是那些血看上去是从他手臂上流出的，没有发现其他的伤口。他的生命体征如下：脉搏：86；呼吸：20；皮肤：粉红，温暖而且干燥；精神状态：警觉而且有判断力，但是焦虑。救援者无法测量伤患的血压。A rescue group arrived at 1700 hours. Upon questioning, the patient stated that the bear bit him several times on the arms. The bear then bit him on the foot and pulled off his boot. The patient had tried to walk out barefoot, but he was unable to walk without his boot. The pt. complained of pain in both arms and his right foot. He stated he had no allergies, took no regular medications, and he had no idea when his last tetanus shot was. He had been drinking water and snacking all day. He remembered the attack in vivid detail. Upon exam, it was noted that the pt. had four puncture/crush wounds of approximately one inch (2.5cm) in depth to each forearm. The wounds had resulted in some moderate blood loss but none of the wounds was actively bleeding at the time of the exam. A three inch (7.5cm), fairly shallow laceration was noted on the bottom of the patient’s right foot. The pt. had blood on his face and neck, but the blood appeared to have come from his arms as no additional wounds were noted. His vitals were as follows: Pulse: 86; Resp: 20; Skin: pink, warm, and dry; mental status: alert and oriented, but anxious. The rescuers were unable to take the patient’s blood pressure.将上述故事中的合适信息填入SOAP笔记中的正确位置。Put the appropriate information from the above story into the correct spaces provided in the SOAP note.给出一份评估，识别出预期问题，并且基于你在1700时所知的情况，对伤患给出处治计划。Develop an Assessment, identify the anticipated problems, and create a treatment plan for this patient, based on what you know at 1700 hours.在1730时，伤患的生命体征在重测之后如下：脉搏：78；呼吸：14；皮肤：粉红，温暖而且干燥；精神状态：警觉而且有判断力，但是为熊有可能回来这件事而感到焦虑。1730时，伤患开始埋怨很冷，而且开始发抖。At 1730 hours, the patient’s vitals were take again and were as follows: Pulse: 78; Resp: 14; Skin: pink, warm, ad dry; mental status: alert and oriented, but anxious that the bear would return. At 1730, the patient began complaining of being cold and started to shiver.修改你的SOAP笔记，以反应出伤患在1330时的变化。Modify your SOAP note to reflect any changes noted at 1730.事故发生地点距离小路尽头接近一个小时（步行）；小路尽头距离最近的诊所1.5小时车程。如果伤患可以行走，协助他走出去（到小路尽头）大概全程需要消耗三个小时。如果伤患不能行走，用担架抬出去需要三个小时（到达小路尽头）。附近有一辆全地形车ATV，但是ATV大概要开三个小时才能到达伤患所在处。除了寒冷的温度以外，没有其他的重大天气问题。This incident occurred roughly one hour (by foot) from a trailhead; the trailhead was a 1.5 hour drive to the nearest clinic. If the patient is able to walk, an assisted walk out (to the trailhead) would take around three hours. If the patient is unable to walk, a litter carry-out would take about three hours (to the trailhead). An ATV is available nearby, but it would take around three hours to get the ATV to the patient. There are no major weather concerns other than cooling temps.请描述你的撤离后送计划。describe evacuation plan.

呼吸系统RESPIRATORY SYSTEM

列出HACE不同阶段的体征，症状和处治。List the signs, symptoms, and treatment for the different stages of HACE.

关于体温调节的考虑Thermoregulatory considerations

案例3：滑雪摔倒FALL, SKIING一组年轻男性见天气晴好便滑雪出了边界，进入了一片著名的陡峭滑道。当时的雪道情况十分恶劣：因为前几天来回的融雪/冻结，雪道上面全是冰渣。两个滑雪者选择了一条最陡峭最狭窄的雪道进行下滑。两人几乎一上坡就开始失去控制。目击者表示两人当时速度越来越快，装备开始从身上掉落，在雪道底部撞击到树木弹起后消失了。没有受伤的滑雪者们向附近的雪地巡逻队求救。尽管响应人们尽快进行了响应，他们到达伤患所在地点时（从发生事故开始）还是过去了45分钟。第一组巡逻员在10:00时到达，发现在树底下有一个年轻男性；第二个滑雪者则是在雪道底部。A group of young males, inspired by sunny weather, skied out of bounds, into a area that had a reputation for steep-chute skiing. The conditions at the time were treacherous; the chutes were sheathed in ice from days of a recent melt/freeze cycle. Two of the skiers chose one of the steepest and tightest of the chutes as their descent route. Both lost control almost immediately after skiing onto the slope. Witnesses stated that the two picked up speed, lost their equipment, and started bouncing off trees before disappearing into the bottom of the chute. The uninjured skiers reported the accident to nearby ski patrollers. Although the responders responded as soon as possible, 45 minutes passed (from time of incident) before rescuers reached the patients. The first patrollers arrived at 1000 hours to find one young male at the base of a tree; the second skier was found at the bottom of the chute.经过检查，伤患一号没有反应并且没有脉搏。在检查了整整一分钟的颈动脉之后，伤患被诊断为心脏停跳。On exam, patient #1 was unresponsive and pulseless. After checking his carotid pulse for a full minute, the patient was determined to be in cardiac arrest.经过检查，伤患二号呼吸作汩汩声。他对疼痛有反应。伤患头部有严重创伤并且伴有变形，他的脸部和后侧颅骨肿胀。伤患二号呼吸道中有许多血液。呼吸道立刻被清理，并且对其进行了正压通气。伤患表现出严重的呼吸窘迫。左前和左侧的胸壁有捻发音。左侧呼吸声缺失。他的前腹部膨胀并且有压痛感。四肢没有明显变形，但是稳定或移动伤患下肢时他会大声呻吟。四肢的CSM表现为完好。On exam patient #2 was found with gurgling respirations. He was pain responsive. Significant trauma was noted on his head with deformity and swelling around the face and the posterior skull. Patient #2 had a significant amount of blood in his airway. The airway was immediately cleared and PPV was initiated. The patient presented with severe respiratory distress. There was crepitus noted in his L anterior and lateral chest wall. Breath sounds were absent on the L side. His anterior abdomen was distended and tender. No gross deformities were noted in the extremities, but the patient moaned loudly when his lower extremities were stabilized or moved. The CSM in all four extremities appeared to be intact.伤患二号的生命体征如下：脉搏：140且虚弱；呼吸40且极度费力；血压：180/P；皮肤：苍白，冷，湿；精神状态：AVPU为P。没测伤患的体温。Patient #2’s vitals were as follows: pulse: 140 and weak; Resp: 40 and extremely labored: B/P: 180 /p; Skin: pale, cool, moist; mental status: P on AVPU. The patient’s temperature was not taken.将上述故事中的两个伤患的合适信息填入SOAP笔记中的正确位置。Put the appropriate information from the above story into the correct spaces provided in a SOAP note for each of the above patients.给出一份评估，识别出预期问题，并且基于你在10:00时所知的情况，对伤患二号给出处治计划。Develop an Assessment, identify the anticipated problems, and create a treatment plan for patient #2, based on what you know at 1000 hours.当伤患到达山底下时，有一架直升飞机可供使用。从现场撤离后送到基地区域的时间大概需要20分钟（在伤患被打包好了之后）。从基地空运走大概另外需要30分钟才能到达创伤中心。Once the patient reached the base of the mountain, a helicopter was available. The evacuation time from the scene (after patient packaging) was roughly 20 minutes to the base area. It was an additional 30 minutes by air to the Trauma Center.

创伤性脑损伤（TBI）和颅内压增高（↑ICP）Traumatic Brain Inury (TBI) and Increased Intracranial Pressure (ICP)

列出一些常见的导致溺水的因素：List some of the general contributing factors to drowning:

接触毒素的处理有哪些一般原则？What are the general principles of toxin exposure management?

阴道炎Vaginitis

牙齿创伤和感染Dental Trauma and Infections

节肢类病媒生物ARTHROPOD DISEASE VECTORS

急性压力反应 (ASR)Acute Stress Reaction (ASR)

炎热相关疾病Heat Related Illnesses

感染Infection

海拔ALTITUDE

伤口法则Wound Protocol

列出具体的例子，说明我们可以怎样阻止海拔疾病。Give specific examples of how altitude sickness can be prevented.

容量性休克Volume Shock