environment+&+exposure

clinical home > primary survey toc =Exposure = In hospital practice the whole patient needs to be exposed for a complete examination. In a wilderness setting, though, it is usual to expose only one part of the patient at a time to limit heat loss. Look for life threatening skin conditions (massive burns, non-blanching rash & erythroderma) and injuries. Check the patient's temperature if you have equipment. If there is no thermometer try to gauge the patient's temperature by touching the skin on their trunk (compare with your own and others' if unsure if it is abnormal).

=Environmental control = Do what you can to prevent the environmental temperature causing the patient's temperature to become abnormal. In the UK cold is the main problem - do whatever can be done to insulate the casualty from the ground and to protect them from wind and rain. **Hypothermia in trauma casualties increases the mortality rate.**

In the UK hill/mountain environment (and many other remote settings) it is likely the casualty will become hypothermic if there is any delay in rescue/evacuation. The rate of heat loss can be slowed in a number of ways: 1) Give warmed oxygen if available (e.g. with little dragon) 2) Any fluids given (oral or vascular) should be warmed 3) Simple carbohydrates will be helpful if the casualty can swallow safely - a sweet drink or some sweets are ideal 4) Try to position them away from wind 5) Insulate them from the ground <span style="font-family: Georgia,serif;">6) Erect a group shelter (see the equipment page of buy recommended books) <span style="font-family: Georgia,serif;">7) Remove the wet clothes if there are dry replacements available <span style="font-family: Georgia,serif;">8) Place the casualty in a warm casualty bag or improvise with a "hypothermia wrap"

<span style="font-family: Georgia,serif;">**Remember that if the casualty is hypothermic then other members of the same group may well be hypothermic too (or at risk of becoming hypothermic). <span style="color: #ff0000; font-family: Georgia,serif;">Look after the rest of the group. **

<span style="font-family: Georgia,serif;">If the environment is one when heat illness is likely to be a problem then the casualty should be moved to shade (if possible) and cooled with evaporative cooling (pour a little water on their clothes at regular intervals). <span style="font-family: Georgia,serif;">Remove insulating clothing/clothing that will retrard hat loss. <span style="font-family: Georgia,serif;">If there is any breeze or wind place the casualt in a position to take advatnge of this if possible. <span style="font-family: Georgia,serif;">A hammock is ideal for increasing heat loss.