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Basic First Aid: Patient Care - Illness

There are many types of illness such as; allergic reactions, altitude sickness, appendicitis, bites and stings, concussions, diabetic emergency, diseases and ailments (i.e. malaria, food and water borne disease, diarrhea and dysentery), fainting, headaches, heat and cold illness, poisoning, shock, seizure, stroke, and vomiting.  Most come on quite suddenly but some can be progressive, especially hot and cold illness.

Allergic Reaction. Some allergic reaction result in anaphylactic shock and a breathing emergency.  Watch the patient for allergic reaction, care for life-threatening conditions (ABC) and keep the victim comfortable.  Some people with allergies carry antihistamine, inhalers or epi-pens, which they should administer themselves.  If someone is having a breathing emergency summons EMS personnel.  For mild allergy symptoms, such as hay fever or hives, give an over-the-counter (OTC) antihistamine. For stuffy nose, give an OTC decongestant. For itchy, watery eyes, use OTC allergy eye drops. For itchy allergic rash, apply cold compresses and an OTC hydrocortisone cream.

Altitude sickness. Acute Mountain Sickness (AMS) commonly occurs above 2,400 meters (8,000 feet). It presents as a collection of nonspecific symptoms, acquired at high altitude or in low air pressure, resembling a case of "flu, carbon monoxide poisoning, or a hangover". A headache occurring at an altitude above 2,400 meters, combined with any one or more of the following symptoms, may indicate altitude sickness; lack of appetite, nausea, vomiting, fatigue, weakness, lightheadedness, dizziness, insomnia, pins and needles, shortness of breath upon exertion, nosebleed, persistent rapid pulse, drowsiness, general malaise, peripheral edema (swelling of hands, feet, and face), and/or diarrhea.  It is hard to determine who will be affected by altitude sickness, as there are no specific factors that correlate with a susceptibility to altitude sickness. AMS can progress to high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE), which are potentially fatal.  Ascending slowly is the best way to avoid AMS. Avoiding strenuous activity in the first 24 hours at high altitude reduces the symptoms of AMS. As alcohol tends to cause dehydration, which exacerbates AMS, avoiding alcohol consumption in the first 24-hours at a higher altitude is wise.  The only reliable treatment and in many cases the only option available is to descend. Attempts to treat or stabilize the patient in situ at altitude is dangerous unless highly controlled and with good medical facilities.

Appendicitis. Pain first, vomiting next and fever last has been described as the classic presentation of acute appendicitis.  Some presentations are atypical and typical presentation may lead to different diagnosis.  If appendicitis is suspected seek medical attention.

Bites and Stings,

Spider Bites/Scorpion Stings. Summons EMS personnel, wash the wound, apply a cold pack, give anti-venom (if available), care for life-threatening conditions (ABC) and keep the victim comfortable.
Snake Bites.  For any snakebite, DO NOT apply ice, cut the wound, apply suction, apply a tourniquet or use electric shock (AED).

If the snake is a viper snake (includes rattlesnakes, copperhead, cotton mouth): Summons EMS personnel, wash the wound and keep the injured area still and lower than the heart.

If the snake is a elapid snake (cobra, mamba, coral, tiger, etc.): Summons EMS personnel, wash the wound, apply an elastic roll bandage and keep the injured area still and lower than the heart.

Insect Stings. Insect stings can be fatal for people who have severe allergic reactions.  This allergic reaction may result in anaphylactic shock and a breathing emergency.  If someone is having a breathing emergency summons EMS personnel.  To care for an insect sting; if the stinger is in the skin scrape it away with a fingernail or plastic card, wash the would with soap and water, cover the site and keep it clean, apply a cold pack, watch the patient for allergic reaction, care for life-threatening conditions (ABC) and keep the victim comfortable.

Concussions or other head injuries are often accompanied by a leakage of watery blood from the nose or ears. Other symptoms may include convulsions, an unresponsiveness of the pupils or headache and vomiting. For a hard hit or severe symptoms seek medical attention.  Keep the injured party warm, dispense a pain killer regularly and allow time for the body to rest and repair.

Diabetic Emergency. People who are diabetic sometimes become ill because there is too much or too little sugar in their blood. Signs and symptoms are fast breathing, fast pulse, dizziness, weakness, change in the level of consciousness, vision difficulties, sweating, headache, numb hands or feet, and hunger.  If the diabetic victim is conscious and can safely swallow food or fluids, give them sugar, preferably in liquid form.  Most fruit juices and non-diet soft drinks have enough sugar to be effective.

Fainting. Fainting is not usually harmful and the victim will usually quickly recover.  Lower the victim to the ground, position them on their back, loosen any tight clothing such as a tie or collar.

Food and Water Borne Illness. There is an array of symptom for food and water borne illnesses.  This group include viral or travelers diarrhea, food poisoning, amoebic dysentery, diarrhea associated with worms, giardia and bacillary dysentery.  It is often difficult to be certain of the causes of food and water borne illness without lab test.  Some food and water borne illness are self-limiting, and the quicker they come the quicker they go.  If diarrhea is present always need to treat for dehydration.  If there is blood or mucus in the stool or the symptoms last more than 72 hours seek medical attention.

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DIARRHEA CHART

Disease         Incubation      Duration     Frequency      Char‑      Blood          Mucus     Fever        Nausea/      Cramps   Treatment
                      Period                               of stools         acter                                                            Vomiting
------------------------------------------------------------------------------------------------------------------------------------------------------------------------Viral &          12‑72hrs      12‑72hrs     Every 15‑       Runny      Rare           Rare        Common     Common    Common     1, 2
Travelers                                               30 min.            stool                                           102 F          not              not
Diarrhea                                                                        brown                                                           severe        severe
------------------------------------------------------------------------------------------------------------------------------------------------------------------------Food             Rapid 4‑24    12‑24 hrs    Variable          Soft         Never          Never      Never         Common    Always,    1, 2
Poisoning      hrs.after                             but                  stool                                                                               not
                      eating                                 severe                                                                                                  severe
------------------------------------------------------------------------------------------------------------------------------------------------------------------------Amoebic        Slow             Chronic       Initially            Normal      Common      Always    Low if        Not            Common,       3
Dysentery     days/                                not true          to soft       in small                        present      present       not
                      Weeks                              diarrhea,         ‑‑may      amounts                                                         severe
                                                               may become   become
                                                               severe             liquid
------------------------------------------------------------------------------------------------------------------------------------------------------------------------Diarrhea        Slow              Variable      Usually           Normal     Never          Never       Never         Not            Common,       3
Associated                                             not                  to soft                         present                                         usually
with worms                                            diarrhea                                                                                                   mild
------------------------------------------------------------------------------------------------------------------------------------------------------------------------Giardia          1‑4 weeks     Chronic      Diarrhea         Loose        No               Yes          Low,        Nausea,      Not            1, 2,3
                                                               to consti‑       stool to                                                          sulfuric        severe 
                                                               pation             formed                                                          gas burps
------------------------------------------------------------------------------------------------------------------------------------------------------------------------Bacillary       1‑7 days       3‑10 days   Every 15‑      Watery      Common    Common     Always        Yes          Yes          1, 2, 4
Dysentery                                              30 min.            stool                                              high                            severe        if not severe.
                                                                                                                                                                                                 3 if severe
-------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------

*   1 ‑ Bed rest.   2 ‑ Liquid diet.   3 ‑ Requires physician and medication.   4 ‑ Aspirin or Tylenol

Headaches. Headaches are often experienced on adventures due to inadequate eye protection, tension in the neck, constipation or "water intoxication" (a swelling of the brain tissue which happens when the participant has sweated excessively over a period of days and consumed large quantities of water without taking salt tablets). Aspirin may be used to alleviate the pain but one should find the source of headache to prevent further discomfort.  Headaches are also a symptoms of altitude sickness, concussion, heat exhaustion, malaria, and stroke, so check for other signs as well.

Heat and Cold Illness. Exposure to heat or cold can lead to illness.  Wind, humidity, ventilation and a person’s physical activity, age, nutrition and state of health can also play a role

Heat-related emergencies. Heat-related emergencies are progressive conditions.  If recognized in the early stages they can usually be reversed. If not they may progress to a life-threatening condition (heat stroke). 

                  Heat cramps. Painful muscle spasms (usually in the legs and abdomen) are an early sign of heat related illness.  There are two basic causes of heat cramping: One is inadequate oxygenation of muscle, and the other is lack of water or salt. Cramps can occur when lactic acid builds up from anaerobic muscle metabolism. When muscles burn sugar without enough oxygen, they make lactic acid. When lactic acid becomes concentrated enough it can trigger muscle contractions. When the muscle lacks salt, the nerves firing the muscle are unable to recharge properly, causing a similar effect. 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.

                  Heat exhaustion is when the bodies cooling system is becoming overwhelmed, is more severe.  Early signs and symptoms are: Excessive sweating, fatigue, thirst, muscle cramps and headache. Later, more serious signs are; cool, moist, pale, ashen or flushed skin, nausea and vomiting, dizziness, exhaustion, and/or dark urine.

                  Heat stroke is when the bodies cooling system is overwhelmed by heat and stops functioning.  Symptoms are: Red, hot, dry skin, changes in level of consciousness, confusion, seizures, vomiting or dry heaves, shallow breathing and a weak rapid pulse.  Watch for signs of shock.

                  Treatment for heat-related emergencies is: move patient to a cool placer, loosen or remove clothing, apply cool, wet towels to the skin (especially where blood vessels are near the surface on the neck, head, groin, and under the arm pit), fan the patient.  If the patient vomits place them on their side.  If the person is awake encourage them to sip a half cup of salt beverage every 15 minutes. DO NOT give liquids that contain alcohol or caffeine. These are diuretics and will hinder the body's ability to re-hydrate.

Heat Stress Index

Cold-related emergencies.

Hypothermia. This occurs when a victim’s entire body cools because they are unable to keep warm (the core body temperature falls below 33.7C (92.6F)). If a person is wet and in a mild wind, it can occur in less than an hour at temperatures as high as 15°C (59°F). Signs and symptoms are: Shivering, numbness, a glassy stare, apathy, weakness, impaired judgment, and/or loss of consciousness.  To care for hypothermia move the victim to a warm place, remove any wet clothing, dry the victim, and work to warm the victim.  Do not warm the too quickly.  Rapid warming may cause dangerous heart rhythms.  If the victim is alert, give them warm liquids to drink that do not contain alcohol or caffeine.

Frostbite.  This occurs when a body part freezes.  Signs and symptoms are: a lack of feeling in the affected area and skin that appears waxy, cold to the tough or discolored (flushed, white, yellow or blue.)  To care for frostbite get the victim out of the cold, warm gently by soaking the affected area in warm water until normal color returns and the area feels warm.  Never rub the affected area. Avoid breaking blisters. If the victim’s fingers or toes are frostbitten, place dry sterile gauze between them to keep them separated. Take precautions to prevent hypothermia.

Ingested Poison. If a person is showing signals of poisoning, call the Poison Control Center (in the USA 1-800-222-1222).  Do not automatically induce vomiting as this may cause burning of the airway if it is a corrosive substance. Do not automatically give fluids to drink as some substances may react more. Treat any life-threatening condition (ABC) and summons EMS personnel.

Inhaled Poison. Poisonous fumes can come from a variety of sources, including carbon monoxide (car exhaust, fires, charcoal grills), chlorine gas, or burning of urushiol containing plants.  Size up the scene to be sure it is safe to help the victim, summons EMS personnel, move the victim to fresh air, care for life-threatening conditions (ABC) and keep the victim comfortable.

Malaria. Malaria may cause one or more of the following symptoms; high fever, chills and profuse sweating, excruciating headache, extreme fatigue and death.  They may be suppressed because of the prophylactic treatment or it may be like a "flu" that does not go away.  The symptoms may come and go in 24, 48 or 72 hour cycles. Generally symptoms get worse in the afternoon and evening. To confuse matters, there are a number of other diseases in most malarial areas that have similar symptoms.  If you experience these symptoms you should contact a physician immediately.  Malaria is detected by a blood smear.  If a physician is not available, the emergency regime for treatment is often a super high dose of prophylactic medicine.  Read the literature with the medicine for details.

Poisonous Plants.  Poison ivy, oak and sumac contain urushiol oil which can be transferred from object to object.  Sensitivity may differ from person to person.  Be careful not to spread the oil. Carefully remove contaminated clothing.  Clean the skin immediately. If you do this within 10 minutes, you may be able to get the urushiol off before it penetrates your skin. Clean the skin with rubbing alcohol first, then rinse thoroughly with cold water. Don’t scrub. Don’t use hot water. Don’t use soap until after an initial thorough rinse with cold water.

Shock. There several type of shock, including; hypovolaemic (low volume of blood from severe bleeding), cardiogenic (heart is pumping poorly) anaphylactic (caused by swelling of the lungs from a severe allergic reaction) and septic (result of severe infection and sepsis). Any serious trauma, injury or illness can cause the condition of shock – a depression of the body’s processes.  Signs and symptoms of shock include: restlessness, irritability, altered level of consciousness, pale or ashen, cool, moist skin, sweating, nausea, vomiting, rapid breathing and pulse and/or excessive thirst.  To minimize the effects; have the victim lie down and elevate the legs (if a head, neck or back injury, or broken bones in the hips or legs are not suspected), monitor the ABCs, control external bleeding, control the victim temperature, DO NOT GIVE FOOD OR DRINK to a victim of shock.

Seizure. Protect the patient from being injured by removing any nearby object that might cause injury.  Protect the patients head by placing a cushion or folded clothing under it.  When the seizure is over, the patient will usually begin to breathe normally.  They may be drowsy and disoriented or unresponsive for a period of time.  If the seizure lasts more than five minute, repeats or there are additional medical conditions summons EMS.

Stroke. Signs of a stroke can be sudden weakness or numbness of the face, arms or leg (usually only on one side), difficulty speaking, blurred or dimmed vision, or sudden, severe headache, dizziness or confusion. Think F.A.S.T. (face, arms, speech, time).  If the signs of a stroke are present summons medical help immediately.  Note the time symptoms began to relay on to medical personnel.

Vomiting. Lower the victim to the ground and position them on their side so that any fluid will drain from the mouth.  Do not give them anything to eat or drink.

Basic First Aid for Bicycle Traveler and Tours

In An Emergency

Patient Care: Illness

Patient Care: Injuries

Return to Education: Bicycle Safety and Health Index.

 
 

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