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Wilderness Medical Society - snowmass 2005 (Page 184)

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Wilderness Medical Society - snowmass 2005
Oxygen if available: especially if at high altitude. Do not withhold oxygen because of concerns of
limited oxygen supply( "what if we run out"): relieving ischemia may prevent the progression of
acute LV dysfunction to fatal pulmonary edema.

Descent from high altitude (8,000 feet or 2,500 meters) is recommended if no supplemental
oxygen is available.
Have patient assume semi-sitting position if possible. If shock develops, position head down and
feet up to prevent downward spiral of BP and progressive coronary hypoperfusion.
Warm patient if cold.
If the victim is not in Heart Failure or shock, encourage fluid intake to avoid hypotension and
Use nitrates for shortness of breath, just as you would for chest pain. Nitroglycerin will relieve
pulmonary edema.
If evacuation is impossible (location, weather, terrain, 3
world location , ocean setting) and
victim cannot self-rescue, due to pain or shock, begin self rescue to nearest hospital as soon as
victim is able to move. Reinfarction is usually fatal. Continue Aspirin, betablockers and
clopidogrel indefinitely until medical care is reached. Use nitrates as needed if exertional angina
develops. Use nitroglycerin prophylactically during exertion every 10-15 minutes to prevent
angina if self rescue is attempted, and efforts at self rescue bring on chest pain.
Adjunctive pain medications with narcotics and anti-anxiety medications will help reduce ischemia
and fear. 15% of patients are aspirin resistant and extra aspirin may help.
Pulmonary edema can be treated with rotating extremity tourniquets constructed of ace bandages
and rotated between limbs every 10 minutes Apply tourniquets enough to impede venous return,
but not tight enough to cut off distal arterial pulsations.
Patients should be instructed early in the first minutes of their infarction to cough deeply and
repetitively if they feel they are about to faint. Coughing will increase arterial pressure and prevent
loss of consciousness during prolonged (minutes) of bradycardia or episodes of ventricular
tachycardia. Patients in ventricular fibrillation will lose consciousness immediately and will not be
able to sustain consciousness for more than a few seconds despite coughing.

Brief episodes of unconsciousness and electromechanical collapse or cardiac arrest should be
treated with CPR aggressively. Many inferior infarction patients will have 2-3 minutes of asystole
which will resolve with vigorous CPR and Basic Life Support.
Sudden Cardiac Arrest should be treated with chest thumps in the hopes of converting a rapid V-
tach to sinus rhythm.

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