Trail Sense

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2 - Medical

This chapter covers basic medical knowledge and techniques for common injuries and illnesses in the wilderness. It does not substitute professional medical advice/treatment or in-depth first aid guides.

Be prepared

Gear

Necessities:

Optional:

Knowledge and skills

Start by learning how to do the following:

Once you have mastered these skills, you should learn how to do the following:

Common medications

This is a list of common medications hikers might carry. It's not a complete list. Only use these as your doctor says and follow the package directions. Know the side effects, how much to take, and when to take them before your trip.

Allergic reactions

Allergic reactions can range from contact dermatitis (like poison ivy) or bug bites to anaphylaxis, a severe reaction that can be life-threatening.

Symptoms

Severe:

Treatment

  1. Remove the allergen if possible.
  2. If there is a rash, apply calamine lotion or hydrocortisone cream.
  3. Take antihistamine pills.

Severe:

Severe allergic reactions that affect breathing or cause swelling of the face, lips, or tongue require immediate medical attention. If you have an epinephrine auto-injector, use it:

  1. Remove the safety cap.
  2. Hold the injector with the tip against the thigh, midway between the hip and knee.
  3. Press the injector into the thigh until it clicks.
  4. Hold it in place for 10 seconds.
  5. Repeat in 5 to 15 minutes if symptoms persist.
  6. Seek medical attention as soon as possible.

If you have asthma and are having an attack, use your inhaler.

Prevention

Altitude sickness

Altitude sickness is caused by low oxygen levels at high altitudes.

Symptoms

Treatment

Prevention

Bites/attacks: mammals and other animals

Many animals bite when threatened and some can transmit diseases.

Treatment

  1. Wash the wound with soap and water.
  2. Apply antibiotic ointment.
  3. Cover the wound with a bandage. Pack deep wounds with gauze but do not suture or tape them closed.
  4. Seek medical attention if the wound is deep, bleeding, or shows signs of infection.

If a mammal bit you, seek medical attention as soon as possible; you may need rabies shots.

Prevention

Bites: leeches

Leeches attach to your skin and suck your blood. They can be found in freshwater lakes, ponds, and marshes.

Symptoms

Treatment

  1. Pull it taut (but not too tight).
  2. Slide a fingernail or other flat object between the leech and your skin to detach it.
  3. Flick the leech away before it can reattach.
  4. Clean the wound and apply antibiotic ointment.
  5. Apply a bandage to control bleeding. It is normal for the wound to bleed for a while.

Do not salt, burn, or pull the leech off, as this can cause it to regurgitate into the wound.

Prevention

Bites: snakes

Always look for snakes, especially in areas with tall grass, rocks, or logs. Snakes are most active during the day. Most snake bites are not venomous, but if you don't know the type of snake, treat the bite as venomous.

Treatment

  1. Rinse the bite area with water.
  2. Clean the wound and cover with a bandage.
  3. Remove any rings or jewelry from the affected limb.
  4. Wrap the limb with a bandage, starting at the bite and moving up the limb. The bandage should be tight but not cut off circulation. You should be able to slip a finger under the bandage. If you are bitten by a pit viper (like a rattlesnake), do not bandage or apply compression as this can lead to increased tissue damage.
  5. Keep the limb immobilized, as you would a fracture, and below the level of the heart.
  6. Seek medical attention as soon as possible. Call the hospital ahead of time so they can prepare antivenom if needed.

Do not do the following:

Prevention

Bites/stings: bugs

Many insects can bite or sting you, causing pain, swelling, and itching. Some insects can also transmit diseases.

Symptoms

Treatment

Bites

To reduce itching, avoid scratching and apply calamine lotion or hydrocortisone cream. To reduce swelling, use a cloth soaked in cold water or filled with snow/ice.

If you were bitten by a spider you believe to be venomous, treat it as you would a snake bite and seek medical attention.

Stings

Remove any stingers, taking care not to squeeze the venom sac. Treat it as if it were a bug bite.

If you were stung by a scorpion or insect you believe to be venomous, treat it as a snake bite and seek medical attention.

Bugs in eyes

See the section on objects in the eye.

Prevention

You can make an improvised bug repellent by applying mud to your skin or using fire smoke.

Bites: ticks

Ticks attach to your skin and will feed on your blood. They can transmit diseases such as Lyme disease and Rocky Mountain spotted fever.

Symptoms

Treatment

  1. Using tweezers if available, grasp the tick where it is attached to the skin.
  2. Pull straight out with steady, even pressure. Do not twist or jerk the tick. Do not squeeze the tick's body.
  3. Treat the area as you would for a bug bite.

Prevention

Bleeding

Treatment

Seek medical attention if the wound is deep, bleeding profusely, or shows signs of infection. Infected wounds can be identified by redness, swelling, warmth, and pus.

Scrapes and minor cuts

  1. Clean the wound with water.
  2. Optionally, apply antibiotic ointment.
  3. Apply a bandage. You can use medical grade superglue if needed.

Deeper cuts

  1. Apply pressure to the wound with a clean cloth or bandage. You may need to apply pressure for about 10 to 20 minutes.
  2. Clean the wound and irrigate it with water.
  3. Bandage the wound with a sterile dressing.
  4. Place new bandages over the old ones if they become soaked with blood.
  5. Raise the wound above the level of the heart.
  6. Seek medical attention if bleeding does not stop or if the wound is deep.

You can apply a tourniquet to stop blood flow if direct pressure does not work on a limb. This should only be done as a last resort, as it can cause permanent damage. Only a medical professional should remove a tourniquet.

Prevention

Blisters

Symptoms

Treatment

If the blister is small:

  1. Cut a doughnut-shaped piece of moleskin.
  2. Place the moleskin around the blister, with the blister in the hole.

If the blister is large or painful:

  1. Sterilize a needle with alcohol or heat.
  2. Pierce the blister near the edge and drain the fluid.
  3. Clean and wash the area.
  4. Apply a bandage and, optionally, antibiotic ointment.

Prevention

Burns

Treatment

First-degree burns

This is about the level of a mild sunburn.

  1. Soak with cool water for 5 minutes.
  2. Optionally, take pain relievers.
  3. Apply aloe vera gel, calamine lotion, or hydrocortisone cream.

Second-degree burns This is a burn that blisters and can be very painful.

  1. Soak with cool water for at least 15 minutes.
  2. Take pain relievers.
  3. Pat the area dry.
  4. Apply a loose bandage.

Do not pop blisters.

Third-degree burns This is a burn that goes through all layers of skin and may be life-threatening. Pain may be minimal due to nerve damage. Second-degree burns are likely also present.

  1. Call emergency services.
  2. Soak with cool water.
  3. Remove clothing and jewelry from the area.
  4. Drink water with electrolytes.
  5. Bandage loosely.

Prevention

Choking

If you are choking and someone is nearby, place your hands on your throat to signal that you are choking.

Treatment

Perform the Heimlich maneuver on yourself:

  1. If possible, bend over a hard surface.
  2. Make a fist with one hand.
  3. Place the thumb side of your fist against your abdomen, below your ribcage and above your navel.
  4. Grasp your fist with your other hand and press into your abdomen with a quick upward thrust.

Perform the Heimlich maneuver on someone else:

  1. Stand behind the person.
  2. Reach around the person's waist.
  3. Make a fist with one hand.
  4. Place the thumb side of your fist against the person's abdomen, below the ribcage and above the navel.
  5. Grasp your fist with your other hand and press into the person's abdomen with a quick upward thrust.

Cramps

Cramps can be caused by dehydration, overexertion, or lack of electrolytes.

Symptoms

Treatment

Prevention

Dehydration

Symptoms

Treatment

Rehydrate by drinking water, an electrolyte solution, or tea.

Prevention

Embedded fishhooks

Fishhooks are designed to penetrate flesh and are difficult to remove without causing further injury. Unless you need to remove the hook to prevent further injury, it's best to leave the hook in place and seek medical attention.

Treatment

Do not attempt to remove a fishhook if it is embedded in the eye.

Method 1

  1. Advance the hook through the skin until the barb is exposed.
  2. Cut the barb off with wire cutters like those on a multitool or pliers.
  3. Pull the hook opposite from how it entered; it should come out easily.
  4. Clean the wound and apply antibiotic ointment.

Method 2

  1. Run a fishing line or cordage through the bend of the hook.
  2. Grab the ends of the string.
  3. Apply downward pressure on the eye of the hook.
  4. Quickly pull the string, causing the hook to come out the way it went in.
  5. Clean the wound and apply antibiotic ointment.

Prevention

Fractures

A fracture is a broken bone. A fracture can be closed (bone is broken, but skin is intact) or open (bone is broken and protruding from the skin).

Symptoms

Treatment

If the bone is out of place and medical attention is unavailable for several hours, you may need to set it. Otherwise, splint it in place and seek medical attention.

Setting a bone

  1. Irrigate and clean the wound if the bone is protruding.
  2. Grab the limb below the fracture.
  3. Pull the limb to straighten the bone. It may pop into place, and pain may decrease.
  4. Splint the bone while holding it in place.
  5. Cover the open wound with a sterile dressing and bandage.

Splinting a bone

  1. Remove all jewelry and tight clothing from the area.
  2. Apply padding around the fracture.
  3. Construct a splint using a rigid object (stick, trekking pole, tent pole). It should extend past the bone break on both sides.
  4. Secure the splint with bandages, tape, or cordage. It should be tight but not cut off circulation. If splinting a finger, tape it to the one next to it.
  5. Apply a sling if the fracture is in the arm to help immobilize the limb.

Prevention

Frostbite

Frostbite is caused by exposure to cold temperatures, which freezes the skin and underlying tissues. If not treated, it can lead to permanent damage.

Symptoms

Frostnip:

Frostbite:

Treatment

Frostnip:

Rewarm the area using body heat (place a hand under the armpit), warm water, or a hand warmer.

Frostbite:

Only thaw the area if you can keep it thawed. Refreezing can cause more damage. Do not use a fire to thaw the area. Do not rub the area. Seek medical attention as soon as possible.

  1. Take pain medicine before thawing.
  2. Prepare hot water (104-108°F / 40-42°C).
  3. Thaw the area for 30 to 45 minutes or until it is pink/red and soft. If the water cools, change it - remove the area from the water before changing it.
  4. Wrap the area in a sterile dressing and keep warm.

Prevention

Gastrointestinal issues

Gastrointestinal issues can be caused by contaminated food or water.

Symptoms

Treatment

Prevention

Headache

Headaches can be caused by various factors, such as dehydration, stress, lack of sleep, or illness.

Treatment

Prevention

Heart problems

To be safe, seek medical attention if you experience chest pain as soon as possible.

Symptoms

Treatment

  1. Stop and sit comfortably.
  2. If you have as-needed heart medication, take it. Otherwise, take aspirin. Chew the aspirin for faster absorption.
  3. Call emergency services and have help come to you.

If someone else does not have a pulse, perform CPR.

CPR:

  1. Check for responsiveness and pulse.
  2. Call emergency services if there is no pulse, then start CPR.
  3. Place the heel of one hand on the center of the chest.
  4. Place the heel of the other hand on top of the first hand.
  5. Interlock fingers.
  6. Keep your arms straight and your shoulders directly over your hands.
  7. Push hard and fast at least 2 inches (5 cm) at 100 to 120 compressions per minute.
  8. Let the chest rise completely between compressions.
  9. Continue until the patient is responsive, emergency services arrive, or you are too exhausted to continue.

If you are fully trained in CPR, perform rescue breathing after 30 compressions. Otherwise, just do compressions.

Rescue breathing:

  1. Tilt the head back and lift the chin.
  2. Pinch the nose shut.
  3. Give two breaths, each lasting about 1 second and causing the chest to rise.
  4. Repeat the cycle of 30 compressions and two breaths.

Prevention

Heat exhaustion and heatstroke

Heat exhaustion and heatstroke are caused by exposure to high temperatures and dehydration.

Symptoms

Heat exhaustion:

Heatstroke:

Treatment

Heat exhaustion:

  1. Move to a cool place.
  2. Drink a lot of water or an electrolyte solution.
  3. Douse yourself with water or immerse yourself in water.

Heatstroke:

  1. Call emergency services.
  2. Move to a cool place.
  3. Remove excess clothing.
  4. Immerse yourself in water.
  5. Be cautious when rehydrating, as seizures and vomiting can lead to choking.

Prevention

Hygiene

Washing

If you do not have soap, you can substitute white ashes, sand, or loamy soil.

Wash hands:

Teeth

If you do not have a toothbrush, you can clean your teeth with a small stick (fray it by chewing on one end) or a piece of cloth. An inner strand of paracord can be used as dental floss. You can grind up charcoal and combine it with water to make toothpaste.

Feet

Do the following to prevent foot problems:

Clothing

Keep clothing clean and dry. Wash clothes with water and soap or boil them. To dry clothes, hang them in the sun or near a fire (not too close).

Bowel movements and urination

Hypothermia

Hypothermia is caused by exposure to cold temperatures, causing the body to lose heat faster than it can produce.

Symptoms

Treatment

Prevention

Objects in the eye

It is common to get objects in your eye while in the wilderness, such as dirt, sand, bugs, or an eyelash.

Symptoms

Treatment

  1. Avoid rubbing the eye.
  2. Using clean water, irrigate the eye by pouring water into the eye.
  3. If the object is still in the eye, use a mirror to locate it and attempt to remove it using a damp cloth or cotton swab. Be very gentle.
  4. If the object is under the upper eyelid and you have a partner, have them place the tip of a cotton swab in the middle of your upper eyelid and gently fold the eyelid over the cotton swab. They can then remove the object using a damp cloth or cotton swab.
  5. After the object is removed, if the eye feels scratchy, place a cold, damp cloth over it, keep the eye closed and rest, use eye drops, or construct an eye patch using a bandage or cloth.
  6. Seek medical attention if the object is not removed or symptoms persist.

Prevention

Panic attacks and calming techniques

Symptoms

Treatment

  1. Sit down.
  2. Close your eyes.
  3. Do one or more of the following:
  4. Take slow, deep breaths.
  5. Count to 10.
  6. Recite a calming phrase.
  7. Visualize a calming place.
  8. Meditate.
  9. Tense up and relax each muscle.
  10. Listen to music or white noise.
  11. Assure yourself that you will be okay.

Poison ivy and contact dermatitis

Contact dermatitis is caused by contact with poisonous plants, such as poison ivy, poison oak, poison sumac, and stinging nettle.

  1. Poison ivy: A toxic plant with three glossy, pointed leaflets, commonly found in forests, fields, and along trails. Contact with its oil causes itchy rashes and skin irritation.
  2. Stinging nettle: A plant with serrated leaves and tiny stinging hairs, commonly found in moist, shaded areas. Contact causes a painful, itchy rash.

Symptoms

Treatment

  1. Try to remove oil from the plant using soap and water. Sand or dirt can be used as a substitute unless there are blisters.
  2. Dry the area.
  3. Apply calamine lotion or hydrocortisone cream to reduce the itch. If unavailable, apply a tannic acid solution (boil acorns or oak bark in water) or crushed jewelweed.
  4. Optionally, take antihistamine pills to reduce itching.

If you touched stinging nettle, apply mud to the area and remove it when it dries. You can also use tape to pull the small needles out.

Avoid scratching the rash, as it can cause infection. Leave blisters alone.

Prevention

Learn to identify and avoid contact with the following plants:

If you come into contact with these plants, wash the area with soap and water as soon as possible. Do not wait for a rash to appear. Do not burn these plants, as the smoke can cause irritation.

Sleeping

Falling asleep can be difficult in the wilderness, but getting adequate rest is important for maintaining energy. To help yourself fall asleep, wind down at night by avoiding strenuous activity and calming your mind, perhaps using meditation. Ensure you aren't too hot or cold and that your sleeping area is comfortable. You might find it easier to sleep if you make a pillow by stuffing spare clothing or a stuff sack with dry leaves or other soft materials.

Some people may also find it necessary to block out noise using earplugs or listening to music or white noise if available.

Snow blindness

Snow blindness is caused when too much sunlight reflects off snow, ice, or water into your eyes.

Symptoms

Treatment

Cover your eyes with a dark cloth until symptoms disappear.

Prevention

Wear UV-protective sunglasses or snow goggles. If you do not have these, you can make snow goggles from a piece of cloth or a piece of bark with slits cut in it. You can also put soot under your eyes to reduce glare.

Splinters, thorns, spines, and needles

Splinters and thorns can be painful and may lead to infection if not removed.

Treatment

If the splinter is deep or very large, seek medical attention and do not try to remove it yourself.

  1. Inspect the splinter to see if any part is exposed and determine which direction it entered.
  2. If no part is exposed, sterilize a needle using hand sanitizer or a flame and gently use it to expose one end of the splinter.
  3. Use tweezers to grab the exposed end of the splinter, preferably pulling in the opposite direction from how it entered.
  4. Slowly pull the splinter out.
  5. Repeat if any pieces remain.
  6. If the splinter drew blood when removed, treat it as a cut. Applying antibiotic ointment and a bandage won't hurt.

Thorns, spines, and needles can be removed the same way as splinters. Some thorns may be easy to remove without tweezers.

For urchin spines, soak the area in hot (not scalding) water for 10 to 90 minutes before removal.

Prevention

Sprains and strains

Sprains are injuries to a tendon or ligament, while strains are injuries to a muscle or tendon.

Symptoms

Treatment

  1. Rest the injured area.
  2. Ice the area for 24 to 48 hours. You can improvise using a cloth soaked in cold water or filled with snow/ice.
  3. Compress the area with a bandage or splint.
  4. Elevate the area.

Prevention

Submerged in water

Falling through ice

If you fall through the ice, do the following:

  1. Turn back the way you came.
  2. Kick your legs to push yourself onto the ice.
  3. Roll away from the hole.
  4. Crawl on your stomach to safety.
  5. Move to a safe, warm location as quickly as possible.
  6. Get out of wet clothes and into dry clothes.
  7. Use leaves or dry grass as insulation and warm up near a fire.

Rip currents

If caught in a rip current, swim parallel to the shore until you are out of the current. Then, swim back to shore.

Sunburn

Sunburn is caused by prolonged exposure to the sun's ultraviolet (UV) radiation.

Symptoms

Treatment

  1. Get out of the sun.
  2. Run cool water over the burn or apply a cold compress to relieve pain.
  3. To reduce pain and swelling, apply aloe vera gel, calamine lotion, or hydrocortisone cream.
  4. Optionally, take pain relievers.
  5. Drink extra water.

Do not pop blisters.

Prevention

Craft: Sunglasses

You can make sunglasses using a piece of cloth or birch bark with slits cut in it. This helps protect your eyes from UV rays and glare.

Resources

Instructions

  1. Trim a piece of cloth or birch bark large enough to cover your eyes.
  2. Cut small rectangular slits over where your eyes will be. Don't cut the slits while wearing the mask.
  3. Attach cordage to both ends of the mask and ensure it fits snugly on your face.